Provider Demographics
NPI:1356390694
Name:NEWMAN, VIRGINIA SANTOS (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SANTOS
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:STE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4248
Mailing Address - Fax:317-865-8314
Practice Address - Street 1:8865 W 400 N
Practice Address - Street 2:SUITE 175
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-877-2225
Practice Address - Fax:219-877-2230
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10437732086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200043300AMedicaid
IN1043773OtherMEDICAL LICENSE
IN200043300AMedicaid
IN547690AMedicare ID - Type Unspecified