Basic Information
| Provider Information | |||||||||
| NPI: | 1003801325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWMAN | ||||||||
| FirstName: | TERENCE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 RALSTON AVE | ||||||||
| Address2: | DEPT. OF SURGERY | ||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435121396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197836944 | ||||||||
| FaxNumber: | 4194783441 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 RALSTON AVE | ||||||||
| Address2: | DEPT. OF SURGERY | ||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435121396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197836944 | ||||||||
| FaxNumber: | 4194783441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35083084 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 2436984 | 05 | OH | MEDICAID | 7297550 | 01 | OH | AETNA | OTHER | 341893773-008 | 01 | OH | MMO | OTHER | 000000339095 | 01 | OH | ANTHEM | OTHER | 04578 | 01 | OH | PHC | OTHER | P00135976 | 01 | OH | RRMC | OTHER | 20-03236 | 01 | OH | UHC | OTHER |