Provider Demographics
NPI:1427614437
Name:STEWART, SHAI IAN BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:SHAI
Middle Name:IAN BERNARD
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:HOWARD UNIVERSITY HOSPITAL - SURGERY PROGRAM OFFICE
Mailing Address - Street 2:2041 GEORGIA AVENUE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060
Mailing Address - Country:US
Mailing Address - Phone:202-865-4833
Mailing Address - Fax:202-865-1773
Practice Address - Street 1:HOWARD UNIVERSITY HOSPITAL - SURGERY PROGRAM OFFICE
Practice Address - Street 2:2041 GEORGIA AVENUE
Practice Address - City:WASHINTON
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-4833
Practice Address - Fax:202-865-1773
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2020-02-11
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-02-11
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMTL005252390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program