Provider Demographics
NPI:1922026046
Name:STEWART, THOMAS K (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:K
Last Name:STEWART
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-2008
Mailing Address - Country:US
Mailing Address - Phone:843-423-0760
Mailing Address - Fax:843-423-8138
Practice Address - Street 1:1205 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2008
Practice Address - Country:US
Practice Address - Phone:843-423-0760
Practice Address - Fax:843-423-8138
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA212363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1089PAMedicaid
SCGP5462OtherMEDICAID GROUP
SC1089PAMedicaid
SCGP5462OtherMEDICAID GROUP
SCAA56059493Medicare PIN