Provider Demographics
NPI:1144374901
Name:STEWART, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 MORTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2210
Mailing Address - Country:US
Mailing Address - Phone:610-532-4306
Mailing Address - Fax:610-532-6536
Practice Address - Street 1:8 MORTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2210
Practice Address - Country:US
Practice Address - Phone:610-532-4306
Practice Address - Fax:610-532-6536
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039631L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001006662Medicaid
PAC30290Medicare UPIN
PA001006662Medicaid