Provider Demographics
NPI:1558587253
Name:STEWART, BENJAMIN LESLIE II (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LESLIE
Last Name:STEWART
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1100 MONTOUR RD
Practice Address - Street 2:
Practice Address - City:LOYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17047-9200
Practice Address - Country:US
Practice Address - Phone:717-789-3553
Practice Address - Fax:717-789-3198
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021844000001Medicaid
PA129744F6KMedicare PIN