Provider Demographics
NPI:1851379226
Name:STEWART, CHRISTOPHER WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WADE
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:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0819
Mailing Address - Country:US
Mailing Address - Phone:910-897-6423
Mailing Address - Fax:910-897-2540
Practice Address - Street 1:25 NORTH JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:COATS
Practice Address - State:NC
Practice Address - Zip Code:27521
Practice Address - Country:US
Practice Address - Phone:910-897-6423
Practice Address - Fax:910-897-2540
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001207546174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0123LOtherBCBS IDENTIFIER NUMBER
NC0123LOtherBCBS IDENTIFIER NUMBER
NC89014N5Medicare ID - Type UnspecifiedMCAID NUMBER
NC412060502OtherTAX ID NUMBER
NCH33928Medicare UPIN