Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A65480 | CA |
NPI | 1023252335 |
---|---|
Provider Name | Dr. Stewart William Mccallum |
First Address | Villanova, PA 19085-1915 |
Second Address | Villanova, PA 19085-1915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2009 |
Last Update Date | 30/04/2009 |