Provider Demographics
NPI:1902010432
Name:NEWBURGER, MARY ROBERTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ROBERTA
Last Name:NEWBURGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10 PARSLEY CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-9519
Mailing Address - Country:US
Mailing Address - Phone:505-989-1718
Mailing Address - Fax:505-982-0900
Practice Address - Street 1:10 PARSLEY CIR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-9519
Practice Address - Country:US
Practice Address - Phone:505-989-1718
Practice Address - Fax:505-989-1718
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE27273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine