Provider Demographics
NPI:1194425652
Name:STEWART, THOMAS WOOD (NP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WOOD
Last Name:STEWART
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 CHURCH HILL DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3720
Mailing Address - Country:US
Mailing Address - Phone:443-458-8236
Mailing Address - Fax:
Practice Address - Street 1:1306 CHURCH HILL DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3720
Practice Address - Country:US
Practice Address - Phone:443-458-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR231498363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health