Healthcare Provider Details

I. General information

NPI: 1205989571
Provider Name (Legal Business Name): FREDRIC NEWMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 POST RD
DARIEN CT
06820-4731
US

IV. Provider business mailing address

722 POST RD
DARIEN CT
06820-4731
US

V. Phone/Fax

Practice location:
  • Phone: 203-656-9999
  • Fax: 718-672-4251
Mailing address:
  • Phone: 203-656-9999
  • Fax: 718-672-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number028727
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: