1962499921 NPI number — KEITH M NEWMAN DPM

Table of content: KEITH M NEWMAN DPM (NPI 1962499921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962499921 NPI number — KEITH M NEWMAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWMAN
Provider First Name:
KEITH
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962499921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 WEST PIKE ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CLARKSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26301-2629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-624-6821
Provider Business Mailing Address Fax Number:
304-624-6840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 WEST PIKE ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CLARKSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26301-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-624-6821
Provider Business Practice Location Address Fax Number:
304-624-6840
Provider Enumeration Date:
10/04/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  WV00232 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0099501000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386634 . This is a "UMWA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 480006787 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".