Provider Demographics
NPI:1770245847
Name:STEWART, EUGENE JR
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:STEWART
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 JEFFERSON ST NW APT 209
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2941
Mailing Address - Country:US
Mailing Address - Phone:240-801-0118
Mailing Address - Fax:
Practice Address - Street 1:812 JEFFERSON ST NW APT 209
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2941
Practice Address - Country:US
Practice Address - Phone:240-801-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care