Provider Demographics
NPI:1932389335
Name:NEWARK ORTHOPAEDICS,INC.
Entity Type:Organization
Organization Name:NEWARK ORTHOPAEDICS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-344-1229
Mailing Address - Street 1:1272 W MAIN ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2004
Mailing Address - Country:US
Mailing Address - Phone:740-344-1229
Mailing Address - Fax:740-344-1409
Practice Address - Street 1:1272 W MAIN ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2004
Practice Address - Country:US
Practice Address - Phone:740-344-1229
Practice Address - Fax:740-344-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0929777Medicaid
OH0929777Medicaid