Basic Information
Provider Information
NPI: 1003801325
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWMAN
FirstName: TERENCE
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X35083084OHY Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
729755001OHAETNAOTHER
P0013597601OHRRMCOTHER
0457801OHPHCOTHER
00000033909501OHANTHEMOTHER
20-0323601OHUHCOTHER
341893773-00801OHMMOOTHER
243698405OH MEDICAID


Home