Provider Demographics
NPI:1336348796
Name:STEWART, SAMUEL W (DO)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:W
Last Name:STEWART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 337
Mailing Address - Street 2:908 SCARBRO ROAD
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-0337
Mailing Address - Country:US
Mailing Address - Phone:304-469-2905
Mailing Address - Fax:304-465-3180
Practice Address - Street 1:908 SCARBRO ROAD
Practice Address - Street 2:
Practice Address - City:SCARBRO
Practice Address - State:WV
Practice Address - Zip Code:25917-0337
Practice Address - Country:US
Practice Address - Phone:304-469-2905
Practice Address - Fax:304-465-3180
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2363207P00000X, 208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015743Medicaid
WV2033614Medicare PIN
2033612Medicare PIN
WV2032142Medicare PIN
WV2033615Medicare PIN
WV3810015743Medicaid
WV2033612Medicare PIN