Healthcare Provider Details

I. General information

NPI: 1861843369
Provider Name (Legal Business Name): TIMOTHY DANIEL STUART D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CARTHAGE ST
SANFORD NC
27330-4162
US

IV. Provider business mailing address

5453 WADE PARK BLVD APT 103
RALEIGH NC
27607-4292
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019-01097
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2019-01097
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: