Provider Demographics
NPI:1396043402
Name:GERALD W NEWMAN MD LLC
Entity Type:Organization
Organization Name:GERALD W NEWMAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-224-8001
Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 650
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-224-8001
Mailing Address - Fax:410-224-8002
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 650
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-224-8001
Practice Address - Fax:410-224-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD40092207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD40092OtherLISCENSE NUMBER
409ROtherMEDICARE #
1154301331OtherPERSONAL NPI NUMBER
409ROtherMEDICARE #