Provider Demographics
NPI:1588801948
Name:NEWPORT NEUROHOSPITALIST MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NEWPORT NEUROHOSPITALIST MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-764-1454
Mailing Address - Street 1:PO BOX 15847
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-5847
Mailing Address - Country:US
Mailing Address - Phone:949-574-4600
Mailing Address - Fax:949-574-4680
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 401
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-764-1454
Practice Address - Fax:949-764-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18563Medicare PIN