Provider Demographics
NPI:1477688414
Name:STEWART, VIRGINIA ERIN (PA)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ERIN
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:844 WASHINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6664
Practice Address - Country:US
Practice Address - Phone:410-871-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103981174400000X
VA0110003241363AS0400X
MDC0004188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No174400000XOther Service ProvidersSpecialist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0004188OtherSTATE LICENSE
VA0110003241OtherLICENSE
FLPA9103981OtherLICENSE