Basic Information
Provider Information
NPI: 1265492557
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWMAN
FirstName: GEORGE
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: MD PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 E OLNEY AVE
Address2: SUITE 400
City: PHILADELPHIA
State: PA
PostalCode: 19120
CountryCode: US
TelephoneNumber: 2154567000
FaxNumber: 2152542599
Practice Location
Address1: 5401 OLD YORK RD
Address2: SUITE 300
City: PHILADELPHIA
State: PA
PostalCode: 19141
CountryCode: US
TelephoneNumber: 2154567190
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/23/2006
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
2084N0400XMD427784PAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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