Healthcare Provider Details

I. General information

NPI: 1982809513
Provider Name (Legal Business Name): LORI MARIE NEWMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI MARIE BROCKWAY M.D.

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 14TH ST NW
WASHINGTON DC
20009-6865
US

IV. Provider business mailing address

3812 WARREN ST NW
WASHINGTON DC
20016-2235
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-1817
  • Fax:
Mailing address:
  • Phone: 678-592-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD210002025
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: