MEDICARE: NEWTON MEDICAL GROUP

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	173000000X	Legal Medicine

General Provider Information

NPI Number	:	1275800906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWTON MEDICAL GROUP

Provider Business Mailing Address
First Line	:	180 GRAND AVE
Second Line	:	SUITE 100
City	:	OAKLAND
State	:	CA
Zip	:	94612-3741
Country	:	US
Telephone Number	:	510-208-4700
Fax Number	:	510-208-4710

Provider Business Practice Location Address
First Line	:	180 GRAND AVE
Second Line	:	SUITE 100
City	:	OAKLAND
State	:	CA
Zip	:	94612-3741
Country	:	US
Telephone Number	:	510-208-4700
Fax Number	:	510-208-4710

Authorized Official
Title or Position	:	SENIOR DIRECTOR
Name	:	MRS. CORRINNE GOLDBERG
Credential	:
Telephone Number	:	510-208-4700

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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