Healthcare Provider Details

I. General information

NPI: 1255310652
Provider Name (Legal Business Name): CHARMAINE A STEWART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 ARLINGTON PL
MADISON WI
53726-4002
US

IV. Provider business mailing address

1908 ARLINGTON PL
MADISON WI
53726-4002
US

V. Phone/Fax

Practice location:
  • Phone: 608-298-7425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number64607
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number64607
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: