Provider Demographics
NPI:1356315790
Name:ACKERMAN, STEWART GARY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:GARY
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 ALLEGHENY BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-6259
Mailing Address - Country:US
Mailing Address - Phone:814-432-7327
Mailing Address - Fax:
Practice Address - Street 1:464 ALLEGHENY BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-6259
Practice Address - Country:US
Practice Address - Phone:814-432-7327
Practice Address - Fax:814-437-6225
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051938363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091328Medicare ID - Type Unspecified
Q44603Medicare UPIN