Provider Demographics
NPI:1497861157
Name:NEWMAN, CAROL ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:ANNE
Other - Last Name:GILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2510 W DUNLAP AVE
Mailing Address - Street 2:STE. 290
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2737
Mailing Address - Country:US
Mailing Address - Phone:602-789-0344
Mailing Address - Fax:602-870-7566
Practice Address - Street 1:2510 W DUNLAP AVE
Practice Address - Street 2:STE. 290
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2737
Practice Address - Country:US
Practice Address - Phone:602-789-0344
Practice Address - Fax:602-870-7566
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICN082749207Q00000X
TXL4078207Q00000X
AZ49403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ974505Medicaid
AZZ173061Medicare PIN
MIH61039OtherHAP
MI0N83850Medicare ID - Type UnspecifiedMEIDCARE
MIH61039Medicare UPIN
MI0470149OtherBCN
MI16490Other16490