Provider Demographics
NPI:1700814464
Name:STEWART, JONATHAN DREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DREW
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2145 MOUNT PLEASANT BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-3632
Mailing Address - Country:US
Mailing Address - Phone:540-427-9200
Mailing Address - Fax:540-427-3237
Practice Address - Street 1:2145 MOUNT PLEASANT BLVD SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-3632
Practice Address - Country:US
Practice Address - Phone:540-427-9200
Practice Address - Fax:540-427-3237
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427452207Q00000X
VA0101263052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018908690001Medicaid
PA587692OtherHEALTH AMERICA