Provider Demographics
NPI:1942253612
Name:NEWINGTON, EDWIN KEITH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:KEITH
Last Name:NEWINGTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-1180
Mailing Address - Country:US
Mailing Address - Phone:269-621-1345
Mailing Address - Fax:
Practice Address - Street 1:6701 PAW PAW AVE
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-9519
Practice Address - Country:US
Practice Address - Phone:269-468-6430
Practice Address - Fax:269-468-0013
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381368745128OtherCCM HARTFORD ID #
MIED05464OtherHPM PROVIDER ID #
MI06117AOtherBHP COLOMA ID #
MI06116AOtherBHP HARTFORD ID #
MI147163OtherGLHP PROVIDER ID #
MI381368745127OtherCCM COLOMA ID #
MIEN001228OtherBCBS PROV ID #
MIED05464OtherHPM PROVIDER ID #
MI381368745127OtherCCM COLOMA ID #