Provider Demographics
NPI:1023073772
Name:NEWMARK, CHARLES STEPHEN (PHD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEPHEN
Last Name:NEWMARK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EASTOWNE DR
Mailing Address - Street 2:STE 207
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:919-942-5249
Mailing Address - Fax:919-408-0122
Practice Address - Street 1:800 EASTOWNE DR
Practice Address - Street 2:STE 207
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-942-5249
Practice Address - Fax:919-408-0122
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC305103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04156OtherBLUE CROSS BLUE SHIELD
NC28110013Medicare ID - Type Unspecified