Provider Demographics
NPI:1447257514
Name:MEDWID, STEVEN WALTER (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WALTER
Last Name:MEDWID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:MEDWID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-493-2500
Mailing Address - Fax:914-493-1195
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-2500
Practice Address - Fax:914-493-1195
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA812622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30240Medicare UPIN
A21437Medicare PIN