Healthcare Provider Details

I. General information

NPI: 1548137797
Provider Name (Legal Business Name): JEFFREY J EWART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N POTOMAC ST
HAGERSTOWN MD
21740-4810
US

IV. Provider business mailing address

6757 WOODLEY HEIGHTS DR
WARRENTON VA
20186-9662
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-4938
  • Fax:
Mailing address:
  • Phone: 240-476-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024191558
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: