Provider Demographics
NPI:1518917160
Name:STEWARD, BENJAMIN G (PA-C)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:G
Last Name:STEWARD
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 1:905 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6626
Mailing Address - Country:US
Mailing Address - Phone:814-238-8418
Mailing Address - Fax:814-234-2888
Practice Address - Street 1:905 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6626
Practice Address - Country:US
Practice Address - Phone:814-238-8418
Practice Address - Fax:814-234-2888
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP33887Medicare UPIN