Provider Demographics
NPI:1093942922
Name:NEWMAN, MARK WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILSON
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-520-5700
Mailing Address - Fax:
Practice Address - Street 1:1455 NW LEARY WAY
Practice Address - Street 2:STE 250
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5124
Practice Address - Country:US
Practice Address - Phone:206-789-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010941902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093942922Medicaid
WA8941892Medicare PIN