1750839791 NPI number — WHITNEY BEAN STEWART PA-C

Table of content: WHITNEY BEAN STEWART PA-C (NPI 1750839791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750839791 NPI number — WHITNEY BEAN STEWART PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
WHITNEY
Provider Middle Name:
BEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750839791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38B GROVE ST
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
RIDGEFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06877-4665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-438-9557
Provider Business Mailing Address Fax Number:
203-438-6456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38B GROVE ST
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
RIDGEFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06877-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-438-9557
Provider Business Practice Location Address Fax Number:
203-438-6456
Provider Enumeration Date:
09/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  003643 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 003643 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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