Basic Information
| Provider Information | |||||||||
| NPI: | 1720029903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 TECH CENTER DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432301987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6149444800 | ||||||||
| FaxNumber: | 6149444750 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 TECH CENTER DR | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432301987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143962684 | ||||||||
| FaxNumber: | 6143962480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 02/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35048924S | OH | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 0347838 | 01 | OH | RAILROAD MEDICARE | OTHER | 0656384 | 05 | OH | MEDICAID |