Provider Demographics
NPI:1770719486
Name:STEWART, KNOTRESHA FLORETH (MD)
Entity type:Individual
Prefix:DR
First Name:KNOTRESHA
Middle Name:FLORETH
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EHIKIOYA
Other - Middle Name:
Other - Last Name:OSEMOBOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:28 TOWN CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084
Mailing Address - Country:US
Mailing Address - Phone:540-835-0500
Mailing Address - Fax:540-307-5070
Practice Address - Street 1:28 TOWN CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084
Practice Address - Country:US
Practice Address - Phone:540-835-0500
Practice Address - Fax:540-307-5070
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine