Provider Demographics
NPI:1578127874
Name:NEWMAN, RAQUELLE SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:RAQUELLE
Middle Name:SUZANNE
Last Name:NEWMAN
Suffix:
Gender:F
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:PSC 9 BOX 3765
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09123-0038
Mailing Address - Country:US
Mailing Address - Phone:954-593-4295
Mailing Address - Fax:
Practice Address - Street 1:52ND MEDICAL GROUP
Practice Address - Street 2:BUILDING 550
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09123
Practice Address - Country:US
Practice Address - Phone:314-452-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE32807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program