Provider Demographics
NPI:1578538559
Name:NEWMAN, RICHARD MARK (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
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 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 3207
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-241-0870
Mailing Address - Fax:860-241-8296
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 3207
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-241-0870
Practice Address - Fax:860-241-8296
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038589208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001385899Medicaid
G41153Medicare UPIN
020001479Medicare ID - Type Unspecified