MEDICARE: DR. JACK NATHANIEL NEWMAN JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	99-01450	NC
2	207RC0000X	Cardiovascular Disease Physician	48806	KY
3	207RC0000X	Cardiovascular Disease Physician	D75445	MD

General Provider Information

NPI Number	:	1215915012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK NATHANIEL NEWMAN JR. M.D.

Provider Business Mailing Address
First Line	:	3903 BRIAR KNOLL CIR
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-2132
Country	:	US
Telephone Number	:	919-630-1616
Fax Number	:

Provider Business Practice Location Address
First Line	:	3903 BRIAR KNOLL CIR
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-2132
Country	:	US
Telephone Number	:	919-630-1616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	11/09/2017

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