Provider Demographics
NPI:1245397074
Name:STEWART, MICHELLE L (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:STEWART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:LANDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1000 NORLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4229
Mailing Address - Country:US
Mailing Address - Phone:717-267-6363
Mailing Address - Fax:717-217-6937
Practice Address - Street 1:785 5TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4232
Practice Address - Country:US
Practice Address - Phone:717-263-9555
Practice Address - Fax:717-217-4218
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012676207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1605972OtherGATEWAY
PA867633OtherMEDICARE GROUP #
PA2022672OtherHIGHMARK BLUE SHIELD
PA418072OtherUPMC
187784OtherMEDCAST
187784OtherMEDCAST
PA418072OtherUPMC
PA234145FLTMedicare PIN