Provider Demographics
NPI:1720263684
Name:KEITH M NEWMAN, DPM
Entity Type:Organization
Organization Name:KEITH M NEWMAN, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-624-6821
Mailing Address - Street 1:700 W 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 W 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00232213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099501000Medicaid
WVT89973Medicare UPIN
WV8805071Medicare PIN
WV0099501000Medicaid