Provider Demographics
NPI:1033557368
Name:NEWMAN, LARA ROSENWASSER (MD)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:ROSENWASSER
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:ANNE
Other - Last Name:ROSENWASSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 HALTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3403
Mailing Address - Country:US
Mailing Address - Phone:864-458-7956
Mailing Address - Fax:
Practice Address - Street 1:5 STEVENS ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4528
Practice Address - Country:US
Practice Address - Phone:864-458-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD463476207WX0120X
SC85404207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034893550001Medicaid
SC854043Medicaid
PA657812Medicaid