Provider Demographics
NPI:1033103478
Name:STUART, PHILIP JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:STUART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:FL 2
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2099
Practice Address - Street 1:301 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2220
Practice Address - Country:US
Practice Address - Phone:607-733-1153
Practice Address - Fax:607-737-7968
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1911241208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000004938OtherBCBS
NY01412835Medicaid
F46442Medicare UPIN
37730CMedicare ID - Type Unspecified