Healthcare Provider Details

I. General information

NPI: 1417997941
Provider Name (Legal Business Name): MITCHELL ROBERT SWARTZ MD, SCD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PEMBROKE RD
WESTON MA
02493-2247
US

IV. Provider business mailing address

P.O. BOX 81135
WELLESLEY HILLS MA
02481-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-237-3625
  • Fax:
Mailing address:
  • Phone: 781-237-3625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number50134
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number178102
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number50134
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: