=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770719486
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KNOTRESHA FLORETH STEWART M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2009
-----------------------------------------------------
Last Update Date | 10/30/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 TOWN CENTER DRIVE
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-835-0500
-----------------------------------------------------
Fax | 540-307-5070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 TOWN CENTER DRIVE
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-835-0500
-----------------------------------------------------
Fax | 540-307-5070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0101245821
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------