Healthcare Provider Details

I. General information

NPI: 1811993207
Provider Name (Legal Business Name): BRIAN H JEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 MOUNTAIN VIEW DR SUITE 200
WEST MIFFLIN PA
15122-2474
US

IV. Provider business mailing address

PO BOX 644214
PITTSBURGH PA
15264-4214
US

V. Phone/Fax

Practice location:
  • Phone: 412-655-4764
  • Fax: 412-653-3580
Mailing address:
  • Phone: 412-653-3080
  • Fax: 412-650-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD045592L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: