Provider Demographics
NPI:1306841010
Name:SMITH, STEWERT GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:STEWERT
Middle Name:GREGORY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEWART
Other - Middle Name:GREGORY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2710 CENTERVILLE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1652
Mailing Address - Country:US
Mailing Address - Phone:302-993-1300
Mailing Address - Fax:302-993-1400
Practice Address - Street 1:2710 CENTERVILLE RD
Practice Address - Street 2:STE 102
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1644
Practice Address - Country:US
Practice Address - Phone:302-993-1300
Practice Address - Fax:302-993-1400
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002317207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000159601Medicaid
C48761Medicare UPIN