Provider Demographics
NPI:1023003308
Name:STEWART, DAVID WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:STEWART
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 1:209 OLD WATERFORD RD NW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2116
Mailing Address - Country:US
Mailing Address - Phone:703-779-9300
Mailing Address - Fax:703-779-9733
Practice Address - Street 1:209 OLD WATERFORD RD NW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2116
Practice Address - Country:US
Practice Address - Phone:703-779-9300
Practice Address - Fax:703-779-9733
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H47086Medicare UPIN
VA07690L19Medicare ID - Type Unspecified
VAP00438885Medicare PIN