Provider Demographics
NPI:1467449611
Name:NEWMAN, T DAVID
Entity Type:Individual
Prefix:
First Name:T
Middle Name:DAVID
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:
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 13207
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1810
Mailing Address - Country:US
Mailing Address - Phone:412-571-0354
Mailing Address - Fax:412-571-0354
Practice Address - Street 1:6 S MAIN ST
Practice Address - Street 2:SUITE 619
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-6803
Practice Address - Country:US
Practice Address - Phone:724-263-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004606-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01760360Medicaid