Provider Demographics
NPI:1568433274
Name:NEWMAN, GLENN NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:NATHAN
Last Name:NEWMAN
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 1:22411 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2507
Mailing Address - Country:US
Mailing Address - Phone:310-721-9100
Mailing Address - Fax:310-375-1392
Practice Address - Street 1:22411 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2507
Practice Address - Country:US
Practice Address - Phone:310-921-7100
Practice Address - Fax:310-375-1392
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055188207Q00000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA55188LMedicare PIN
CAWA55188MMedicare PIN
CAWA55188LMedicare ID - Type UnspecifiedPPIN