Provider Demographics
NPI:1710061833
Name:ZUKIEWICZ-NEWMAN, MARY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:ZUKIEWICZ-NEWMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:ZUKIEWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:73 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1939
Mailing Address - Country:US
Mailing Address - Phone:740-775-6949
Mailing Address - Fax:
Practice Address - Street 1:STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1939
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1009292363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical