Provider Demographics
NPI:1013094234
Name:STEWART, EDWARD ALLEN (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALLEN
Last Name:STEWART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 INNOVATION DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5261
Mailing Address - Country:US
Mailing Address - Phone:864-235-7665
Mailing Address - Fax:
Practice Address - Street 1:2 INNOVATION DR
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5261
Practice Address - Country:US
Practice Address - Phone:864-235-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL871207R00000X
SC871207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine