Provider Demographics
NPI:1740297233
Name:NEWMAN, LARRY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEE
Last Name:NEWMAN
Suffix:
Gender:M
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:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:BAILEYVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04694-0878
Mailing Address - Country:US
Mailing Address - Phone:207-427-6332
Mailing Address - Fax:207-427-6005
Practice Address - Street 1:163 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BAILEYVILLE
Practice Address - State:ME
Practice Address - Zip Code:04694-0878
Practice Address - Country:US
Practice Address - Phone:207-427-6332
Practice Address - Fax:207-427-6005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126450000Medicaid
ME126450000Medicaid
MEMM2531Medicare ID - Type Unspecified