1396043402 NPI number — GERALD W NEWMAN MD LLC

Table of content: (NPI 1396043402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396043402 NPI number — GERALD W NEWMAN MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERALD W NEWMAN MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1396043402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2002 MEDICAL PKWY
Provider Second Line Business Mailing Address:
SUITE 650
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-3046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-224-8001
Provider Business Mailing Address Fax Number:
410-224-8002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 650
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-224-8001
Provider Business Practice Location Address Fax Number:
410-224-8002
Provider Enumeration Date:
03/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-224-8001

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  D40092 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D40092 . This is a "LISCENSE NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 409R . This is a "MEDICARE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1154301331 . This is a "PERSONAL NPI NUMBER" identifier . This identifiers is of the category "OTHER".




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