Provider Demographics
NPI:1295709400
Name:NEWMAN, KELLEY A (BS)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:A
Last Name:NEWMAN
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Gender:F
Credentials:BS
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Mailing Address - Street 1:ROUTE 12 BLDG 449
Mailing Address - Street 2:ATTN PROFESSIONAL AFFAIRS NAVAL HEALTH CARE NEW ENGLAND
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-2377
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:43 SMITH RD
Practice Address - Street 2:NAVAL HELATH CARE NEW ENGLAND
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1002
Practice Address - Country:US
Practice Address - Phone:860-694-2377
Practice Address - Fax:860-694-3590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
1036564363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN