Provider Demographics
NPI:1588625461
Name:NEWMAN, MICHAEL DOUGLAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:DOUGLAS
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:651 SUNSET LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBER BRIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28357-8980
Mailing Address - Country:US
Mailing Address - Phone:910-875-6216
Mailing Address - Fax:
Practice Address - Street 1:CLARK HEALTH CLINIC
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPA 1001069363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCPA 1001069OtherNATIONAL CERTIFICATION