Provider Demographics
NPI:1962663021
Name:WALTER S. NEWMAN, JR., M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WALTER S. NEWMAN, JR., M.D. A PROFESSIONAL CORPORATION
Other - Org Name:THE NEWMAN MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:408-226-5400
Mailing Address - Street 1:6950 SANTA TERESA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1300
Mailing Address - Country:US
Mailing Address - Phone:408-226-5400
Mailing Address - Fax:408-226-1817
Practice Address - Street 1:6950 SANTA TERESA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1300
Practice Address - Country:US
Practice Address - Phone:408-226-5400
Practice Address - Fax:408-226-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-21
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39525261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G395250Medicare PIN