Provider Demographics
NPI:1700958964
Name:ANN MARIE STUART MD LLC
Entity Type:Organization
Organization Name:ANN MARIE STUART MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-721-8500
Mailing Address - Street 1:970 E WASHINGTON STREET
Mailing Address - Street 2:STE 5A
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:330-721-8500
Mailing Address - Fax:330-721-8510
Practice Address - Street 1:970 E WASHINGTON STREET
Practice Address - Street 2:STE 5A
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-721-8500
Practice Address - Fax:330-721-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080891S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2335413Medicaid
OH2335413Medicaid
OHST4072292Medicare ID - Type Unspecified