Provider Demographics
NPI:1871556043
Name:SCHWARTZBERG, GARY D (AUD, FAAA)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:SCHWARTZBERG
Suffix:
Gender:M
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325D KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4530
Mailing Address - Country:US
Mailing Address - Phone:207-873-7191
Mailing Address - Fax:207-872-6051
Practice Address - Street 1:325D KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4530
Practice Address - Country:US
Practice Address - Phone:207-873-7191
Practice Address - Fax:207-872-6051
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP353237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME26127OtherBLUE SHIELD BILLING #
ME26127OtherBLUE SHIELD BILLING #