Provider Demographics
NPI:1164460226
Name:WASHINGTON NEWARK MEDICAL GROUP
Entity Type:Organization
Organization Name:WASHINGTON NEWARK MEDICAL GROUP
Other - Org Name:WASHINGTON CLINIC/NEWARK
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-797-7535
Mailing Address - Street 1:35500 DUMBARTON CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1127
Mailing Address - Country:US
Mailing Address - Phone:510-797-7535
Mailing Address - Fax:510-797-0236
Practice Address - Street 1:35500 DUMBARTON CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1127
Practice Address - Country:US
Practice Address - Phone:510-797-7535
Practice Address - Fax:510-797-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085450Medicaid
CAGR0085450Medicaid