Provider Demographics
NPI:1225030067
Name:STEWART, TIMOTHY PATRICK (DPM)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:STEWART
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 BUTLER STREET
Mailing Address - Street 2:
Mailing Address - City:PGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-3065
Mailing Address - Country:US
Mailing Address - Phone:412-621-2990
Mailing Address - Fax:412-621-2780
Practice Address - Street 1:7550 SALTSBURG ROAD
Practice Address - Street 2:
Practice Address - City:PGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3633
Practice Address - Country:US
Practice Address - Phone:412-795-5580
Practice Address - Fax:412-795-8735
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003192L213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
77659OtherMED PLUS
1520253OtherBLUE
PA0011356880004Medicaid
104075OtherUPMC
1378739OtherFUNDS
480006376OtherUNITED HC
13886OtherHEALTH AM
13886OtherHEALTH AM
1378739OtherFUNDS