Provider Demographics
NPI:1063497964
Name:STUART, ANN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:330-721-8500
Mailing Address - Fax:330-721-8510
Practice Address - Street 1:4001 CARRICK DR
Practice Address - Street 2:SUITE 150
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5387
Practice Address - Country:US
Practice Address - Phone:330-721-8500
Practice Address - Fax:330-721-8510
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080891208D00000X
OH35-080891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2335413Medicaid
OH4239458Medicare PIN
H26279Medicare UPIN