Basic Information
Provider Information
NPI: 1003006768
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWMAN
FirstName: MAUREEN
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 DATES DR
Address2:  
City: ITHACA
State: NY
PostalCode: 148501342
CountryCode: US
TelephoneNumber: 6072744296
FaxNumber:  
Practice Location
Address1: 101 DATES DR
Address2:  
City: ITHACA
State: NY
PostalCode: 148501342
CountryCode: US
TelephoneNumber: 6072744296
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/30/2007
LastUpdateDate: 11/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QH0002X243402NYY Allopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine

ID Information
IDTypeStateIssuerDescription
0289384105NY MEDICAID


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