Healthcare Provider Details

I. General information

NPI: 1124501861
Provider Name (Legal Business Name): STEWARD EMERGENCY PHYSICIANS OHIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E MARKET ST
WARREN OH
44483-6608
US

IV. Provider business mailing address

9 GALEN ST
WATERTOWN MA
02472-4515
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-9011
  • Fax:
Mailing address:
  • Phone: 617-562-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJAY SHETTY
Title or Position: PRESIDENT OF STEWARD MEDICAL GROUP
Credential: MD
Phone: 617-419-4700