Provider Demographics
NPI:1962499921
Name:NEWMAN, KEITH M (DPM)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:M
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 WEST PIKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2629
Mailing Address - Country:US
Mailing Address - Phone:304-624-6821
Mailing Address - Fax:304-624-6840
Practice Address - Street 1:700 WEST PIKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2629
Practice Address - Country:US
Practice Address - Phone:304-624-6821
Practice Address - Fax:304-624-6840
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVWV00232213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099501000Medicaid
WV1386634OtherUMWA
WV480006787OtherRAILROAD MEDICARE
WVT89973Medicare UPIN
WV8805071Medicare PIN