Provider Demographics
NPI:1679845713
Name:STEWART, MICHAEL V (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:V
Last Name:STEWART
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 1:819 WORCESTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1056
Mailing Address - Country:US
Mailing Address - Phone:413-304-2501
Mailing Address - Fax:413-789-0290
Practice Address - Street 1:819 WORCESTER ST STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1056
Practice Address - Country:US
Practice Address - Phone:413-304-2501
Practice Address - Fax:413-789-0290
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4977363A00000X
TNPA2390363A00000X
MAPA4339363AM0700X
NC0010-03656363A00000X
RIPA00633363A00000X
NH0877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008213Medicaid