Provider Demographics
NPI:1336120765
Name:NEWMAN, PAUL (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF DEFENSE, WRNMMC, BLDG 19 FL 6 RM6131
Mailing Address - Street 2:4954 NORTH PALMER ROAD
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:20889-5630
Mailing Address - Country:US
Mailing Address - Phone:301-400-1955
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF DEFENSE, WRNMMC, BLDG 19 FL 6 RM6131
Practice Address - Street 2:4954 NORTH PALMER ROAD
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:20889-5630
Practice Address - Country:US
Practice Address - Phone:301-400-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5774103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2514587Medicaid
OH2514587Medicaid
OHP46612Medicare UPIN