Provider Demographics
NPI:1215014550
Name:STEWART, KENDALL L (MD)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:L
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 OAKLAND AVE
Mailing Address - Street 2:MOB-B, SUITE 101
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2913
Mailing Address - Country:US
Mailing Address - Phone:740-354-8684
Mailing Address - Fax:740-354-1168
Practice Address - Street 1:1835 OAKLAND AVE
Practice Address - Street 2:MOB-B, SUITE 101
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2913
Practice Address - Country:US
Practice Address - Phone:740-354-8684
Practice Address - Fax:740-354-1168
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350466142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0486433Medicaid
KY64217870Medicaid
OH0510734Medicare ID - Type Unspecified
KY64217870Medicaid