Provider Demographics
NPI:1417064841
Name:NEWBERG, MATTHEW TODD (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TODD
Last Name:NEWBERG
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 1:1933 DUNDEE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4103
Mailing Address - Country:US
Mailing Address - Phone:407-644-1241
Mailing Address - Fax:407-644-3058
Practice Address - Street 1:1933 DUNDEE DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4103
Practice Address - Country:US
Practice Address - Phone:407-644-1241
Practice Address - Fax:407-644-3058
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29661YMedicare PIN
I43859Medicare UPIN