Provider Demographics
NPI: | 1649387507 |
---|---|
Name: | NEWTON, DANIEL J (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | DANIEL |
Middle Name: | J |
Last Name: | NEWTON |
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: | 1761 BEALL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | WOOSTER |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44691-2342 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-263-8428 |
Mailing Address - Fax: | 330-263-8190 |
Practice Address - Street 1: | 1761 BEALL AVE |
Practice Address - Street 2: | SUITE 3A |
Practice Address - City: | WOOSTER |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44691-2342 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-202-5700 |
Practice Address - Fax: | 330-202-5701 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-24 |
Last Update Date: | 2015-11-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35083176 | 207RC0000X, 207RI0011X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2435574 | Medicaid | |
OH | 2435574 | Medicaid | |
OH | H93525 | Medicare UPIN |