Provider Demographics
NPI:1619905338
Name:STEWART, ROSALYN W (MD)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:W
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 1:601 NORTH CAROLINE STREET
Mailing Address - Street 2:SUITE 7.143
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0941
Mailing Address - Country:US
Mailing Address - Phone:410-955-3613
Mailing Address - Fax:410-614-1195
Practice Address - Street 1:601 NORTH CAROLINE STREET
Practice Address - Street 2:SUITE 7.143
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0941
Practice Address - Country:US
Practice Address - Phone:410-955-3613
Practice Address - Fax:410-614-1195
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060151207R00000X
MDDOO60151208000000X
MDD601512080P0203X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402199100Medicaid
MD402199100Medicaid
MDN525Medicare ID - Type Unspecified