Provider Demographics
NPI:1720281017
Name:STEWART, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:ROBERT
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:833 CHESTNUT STREET
Mailing Address - Street 2:SUITE 701
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4409
Mailing Address - Country:US
Mailing Address - Phone:215-955-6180
Mailing Address - Fax:215-955-6410
Practice Address - Street 1:833 CHESTNUT STREET
Practice Address - Street 2:SUITE 701
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4409
Practice Address - Country:US
Practice Address - Phone:215-955-6180
Practice Address - Fax:215-955-6410
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0236438Medicaid
PA102502659 0001Medicaid
PA102502659 0001Medicaid