Provider Demographics
NPI:1164466819
Name:STEWART, KATHLEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:STEWART
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 1:1870 AMHERST ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2873
Mailing Address - Country:US
Mailing Address - Phone:540-662-1108
Mailing Address - Fax:
Practice Address - Street 1:1870 AMHERST ST
Practice Address - Street 2:SUITE F
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2873
Practice Address - Country:US
Practice Address - Phone:540-662-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053239207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6061711Medicaid
VA210244OtherBLUE CROSS BLUE SHIELD
VA45-4759270OtherTAX ID
WV0078452000OtherWV MEDICAID
VAF07835Medicare UPIN
VA45-4759270OtherTAX ID