Provider Demographics
NPI:1508894551
Name:STEWART, ANGELA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024A OLD TAR RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8430
Mailing Address - Country:US
Mailing Address - Phone:252-355-3773
Mailing Address - Fax:252-355-1958
Practice Address - Street 1:4024A OLD TAR RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8430
Practice Address - Country:US
Practice Address - Phone:252-355-3773
Practice Address - Fax:252-355-1958
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-25531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8979842Medicaid
NC79842OtherBCBS NC
NC370011561OtherRR MEDICARE
NC370011561OtherRR MEDICARE
NC8979842Medicaid