Healthcare Provider Details

I. General information

NPI: 1710939426
Provider Name (Legal Business Name): MARK SCHWAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WOODLAND DR
COVENTRY RI
02816-6716
US

IV. Provider business mailing address

10 WOODLAND DR
COVENTRY RI
02816-6716
US

V. Phone/Fax

Practice location:
  • Phone: 401-524-2344
  • Fax: 610-347-4968
Mailing address:
  • Phone: 401-524-2344
  • Fax: 610-347-4968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number06946
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: