Provider Demographics
NPI:1720029903
Name:STEWART, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 TECH CENTER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1987
Mailing Address - Country:US
Mailing Address - Phone:614-944-4800
Mailing Address - Fax:614-944-4750
Practice Address - Street 1:701 TECH CENTER DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1987
Practice Address - Country:US
Practice Address - Phone:614-396-2684
Practice Address - Fax:614-396-2480
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048924S208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0347838OtherRAILROAD MEDICARE
OH0656384Medicaid
OH0635576Medicare PIN
OH0656384Medicaid