Provider Demographics
NPI:1467039438
Name:STEWART, SOFIA BERMUDEZ (MD)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:BERMUDEZ
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N EAST PLZ
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-3633
Mailing Address - Country:US
Mailing Address - Phone:410-287-5570
Mailing Address - Fax:410-287-5123
Practice Address - Street 1:103 N EAST PLZ
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3633
Practice Address - Country:US
Practice Address - Phone:410-287-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0026827207Q00000X
MDD0100091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty