Provider Demographics
NPI:1215116009
Name:JOHN W. STEWART, JR. MD, INC.
Entity type:Organization
Organization Name:JOHN W. STEWART, JR. MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:330-384-1650
Mailing Address - Street 1:224 W EXCHANGE ST
Mailing Address - Street 2:STE 280
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-384-1650
Mailing Address - Fax:330-384-1651
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:STE 280
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-384-1650
Practice Address - Fax:330-384-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4306793OtherAETNA #
OH0852984Medicaid
OH000000283985OtherANTHEM #
OH4306793OtherAETNA #
OH=========026OtherCARESOURCE #
OH0852984Medicaid
OH0861605Medicare PIN