Basic Information
Provider Information
NPI: 1033557368
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWMAN
FirstName: LARA
MiddleName: ROSENWASSER
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ROSENWASSER
OtherFirstName: LARA
OtherMiddleName: ANNE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 550 S JACKSON ST
Address2: SUITE A3K00
City: LOUISVILLE
State: KY
PostalCode: 402021622
CountryCode: US
TelephoneNumber: 5028527040
FaxNumber: 5028528980
Practice Location
Address1: 550 S JACKSON ST
Address2: SUITE A3K00
City: LOUISVILLE
State: KY
PostalCode: 402021622
CountryCode: US
TelephoneNumber: 5028527040
FaxNumber: 5028528980
Other Information
ProviderEnumerationDate: 06/09/2013
LastUpdateDate: 06/09/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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