MEDICARE: MR. STEWART GARY ACKERMAN PA-C

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	363AM0700X	Medical Physician Assistant	MA051938	PA

General Provider Information

NPI Number	:	1356315790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEWART GARY ACKERMAN PA-C

Provider Business Mailing Address
First Line	:	700 24TH ST
Second Line	:
City	:	FORT GREGG ADAMS
State	:	VA
Zip	:	23801-1716
Country	:	US
Telephone Number	:	804-734-9159
Fax Number	:	877-874-1008

Provider Business Practice Location Address
First Line	:	700 24TH ST
Second Line	:
City	:	FORT GREGG ADAMS
State	:	VA
Zip	:	23801-1716
Country	:	US
Telephone Number	:	804-734-9159
Fax Number	:	877-874-1008

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	02/04/2025

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