Provider Demographics
NPI:1811196314
Name:STEWART, ANITA R (DO)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:STEWART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:R
Other - Last Name:SAYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 STEVENS RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-9704
Mailing Address - Country:US
Mailing Address - Phone:304-872-5329
Mailing Address - Fax:
Practice Address - Street 1:1 STEVENS RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9704
Practice Address - Country:US
Practice Address - Phone:304-872-5329
Practice Address - Fax:304-574-3960
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016406Medicaid
WV3810016406Medicaid
WVWV0351AMedicare PIN
WV2033601Medicare PIN