Provider Demographics
NPI:1780198358
Name:ELAN M. NEWMAN, M.D., INC
Entity Type:Organization
Organization Name:ELAN M. NEWMAN, M.D., INC
Other - Org Name:DERMCONSULT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DERMATOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAN
Authorized Official - Middle Name:MORDECI
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-730-1629
Mailing Address - Street 1:6736 LOPEZ GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6112
Mailing Address - Country:US
Mailing Address - Phone:858-952-0715
Mailing Address - Fax:
Practice Address - Street 1:11622 EL CAMINO REAL FL 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2049
Practice Address - Country:US
Practice Address - Phone:858-952-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-18
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100748207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty