Provider Demographics
NPI:1265723647
Name:STEWART, KATHERINE IKARD (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:IKARD
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S CONKLING ST APT 345
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5323
Mailing Address - Country:US
Mailing Address - Phone:443-695-8458
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF GYNECOLOGY AND OBSTETRICS
Practice Address - Street 2:600 NORTH WOLFE STREET, PHIPPS 279
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR3761207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398438701Medicaid
TX398438702OtherMEDICAID-CSHCN
TX8LB581OtherBCBS