Provider Demographics
NPI:1891032975
Name:CONSTANT STEWART, MONIFA
Entity Type:Individual
Prefix:
First Name:MONIFA
Middle Name:
Last Name:CONSTANT STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 ELDBRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-7350
Mailing Address - Country:US
Mailing Address - Phone:301-758-0196
Mailing Address - Fax:
Practice Address - Street 1:3912 ELDBRIDGE TER
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-7350
Practice Address - Country:US
Practice Address - Phone:301-758-0196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC523609974401172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver