Provider Demographics
NPI:1235117813
Name:SWARTZ, CONRAD M (MD, PHD)
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:M
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 NW 25TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2036
Mailing Address - Country:US
Mailing Address - Phone:360-597-3754
Mailing Address - Fax:888-523-2128
Practice Address - Street 1:12911 NW 25TH CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2036
Practice Address - Country:US
Practice Address - Phone:360-597-3754
Practice Address - Fax:888-523-2128
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD279842084P0800X, 2084P0805X
WAMD000489162084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8532251Medicaid
IL036064553Medicaid
ILL73228Medicare ID - Type Unspecified
WA8532251Medicaid