Provider Demographics
NPI:1164403523
Name:STEWART, MICHAEL P (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
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 1:570 HUNTSMAN PATH
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-388-2607
Mailing Address - Fax:610-345-1762
Practice Address - Street 1:570 HUNTSMAN PATH
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:610-388-2607
Practice Address - Fax:610-345-1762
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018787E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009220910001Medicaid
PAC30566Medicare UPIN
PA116147Medicare ID - Type Unspecified