Healthcare Provider Details

I. General information

NPI: 1720114838
Provider Name (Legal Business Name): NANCY B STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N CAYUGA ST
ITHACA NY
14850-4219
US

IV. Provider business mailing address

404 N CAYUGA ST
ITHACA NY
14850-4219
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-5551
  • Fax: 607-275-0313
Mailing address:
  • Phone: 607-273-5551
  • Fax: 607-275-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number153705
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: