Healthcare Provider Details

I. General information

NPI: 1265616650
Provider Name (Legal Business Name): GREGORY B STEWART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7853 PACER DR
DELAWARE OH
43015-7571
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-7900
  • Fax:
Mailing address:
  • Phone: 614-722-2000
  • Fax: 614-722-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35083948
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: