Provider Demographics
NPI:1730139148
Name:NEWMARK, HARRIS III (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:
Last Name:NEWMARK
Suffix:III
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 1:227 TOYOPA DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4463
Mailing Address - Country:US
Mailing Address - Phone:310-573-9113
Mailing Address - Fax:310-454-6372
Practice Address - Street 1:227 TOYOPA DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-4463
Practice Address - Country:US
Practice Address - Phone:310-573-9113
Practice Address - Fax:310-454-6372
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG170420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90471Medicare UPIN
CA6656Medicare ID - Type Unspecified