Provider Demographics
NPI:1730262445
Name:SCHWARTZ, LESTER ROBERT (MD)
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:ROBERT
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12179
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4012
Mailing Address - Country:US
Mailing Address - Phone:860-242-8574
Mailing Address - Fax:860-243-0898
Practice Address - Street 1:800 COTTAGE GROVE RD
Practice Address - Street 2:STE 401
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3064
Practice Address - Country:US
Practice Address - Phone:860-242-8574
Practice Address - Fax:860-243-0898
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0255012080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001255017Medicaid