Provider Demographics
NPI:1982666194
Name:STEWART, DAVID J (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:STEWART
Suffix:
Gender:M
Credentials:CRNA
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 14892
Mailing Address - Street 2:VAPCS
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4043
Mailing Address - Country:US
Mailing Address - Phone:844-437-4276
Mailing Address - Fax:
Practice Address - Street 1:760 MCGUIRE PL FL 1
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1630
Practice Address - Country:US
Practice Address - Phone:757-591-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165305367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10073752COtherSENTARA/VHN
VA612052400OtherDEPT OF LABOR/POSTAL SERVICE
VAC09913OtherMEDICARE GROUP PTAN
VA019306V13Medicare PIN
VAC09913OtherMEDICARE GROUP PTAN