Basic Information
| Provider Information | |||||||||
| NPI: | 1639815590 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEWARD MEDICAL GROUP, INC | ||||||||
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| Address1: | 9 GALEN ST STE 240 | ||||||||
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| City: | WATERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024724522 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1350 E MARKET ST | ||||||||
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| City: | WARREN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444836608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308419011 | ||||||||
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| ProviderEnumerationDate: | 05/12/2022 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | GUAY | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6179525891 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.