Healthcare Provider Details

I. General information

NPI: 1164497129
Provider Name (Legal Business Name): STEPHEN LAWRENCE NEWMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 EAST 12TH AVENUE APT 1607
DENVER CO
80203-2529
US

IV. Provider business mailing address

550 EAST 12TH AVENUE APT 1607
DENVER CO
80203-2529
US

V. Phone/Fax

Practice location:
  • Phone: 732-267-2384
  • Fax: 732-920-8066
Mailing address:
  • Phone: 732-267-2384
  • Fax: 732-920-8066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61021963
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number90027
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: