Provider Demographics
NPI:1841265519
Name:NEWMAN, SAMUEL S (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-1600
Mailing Address - Fax:859-344-0091
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-344-1600
Practice Address - Fax:859-344-0091
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY380792086S0129X, 208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00024477OtherRAILROAD MEDICARE
IN200446010Medicaid
KYP00024477OtherRAILROAD MEDICARE
KY09454052OtherSES PHYS SERV KY MCR PTAN
KY64026339Medicaid
KY7100056850Medicaid
OH2475254Medicaid
OH2475254Medicaid
KYK032190Medicare PIN
KY1459518Medicare PIN
OH0633183Medicare PIN
KY64026339Medicaid
KY7100056850Medicaid