MEDICARE: DR. GRETA J. STEWART D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS009710L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235112566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETA J. STEWART D.O.

Provider Business Mailing Address
First Line	:	1412-22 FAIRMOUNT AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2908
Country	:	US
Telephone Number	:	215-684-5344
Fax Number	:	215-232-4093

Provider Business Practice Location Address
First Line	:	1412 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2908
Country	:	US
Telephone Number	:	215-235-9600
Fax Number	:	215-232-4093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	09/24/2021

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