Provider Demographics
NPI:1790852598
Name:NEWMAN, ALYSSA (MD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840
Mailing Address - Country:US
Mailing Address - Phone:203-972-4250
Mailing Address - Fax:203-801-2126
Practice Address - Street 1:173 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840
Practice Address - Country:US
Practice Address - Phone:203-972-4250
Practice Address - Fax:203-801-2126
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
010039737CT1OtherANTHEM BC
00214304001OtherUHC
00139737300OtherBC FAM
P2497533OtherOXFORD
7233119OtherAETNA
00139737300OtherBC FAM
00214304001OtherUHC