Provider Demographics
NPI:1134143498
Name:STEWART, FRAY DYLAN (MD)
Entity type:Individual
Prefix:DR
First Name:FRAY
Middle Name:DYLAN
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 1:600 N WOLFE ST
Mailing Address - Street 2:HARVEY 319
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0005
Mailing Address - Country:US
Mailing Address - Phone:410-955-2960
Mailing Address - Fax:410-502-5314
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:HARVEY 319
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-2960
Practice Address - Fax:410-502-5314
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053844208600000X
MDD538442086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD60645101OtherBLUE SHIELD
MD1701493OtherUNITED HLTHCARE
MD2210485OtherUNITED HLTHCARE NATIONAL
MD252812OtherKAISER
MD061401700Medicaid
MD0103OtherCAREFIRST
MD2138547OtherMDIPA
MD60645101OtherBLUE SHIELD
MD170236YVEMedicare PIN
MD0103OtherCAREFIRST