Healthcare Provider Details

I. General information

NPI: 1164593216
Provider Name (Legal Business Name): MARY NEWMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US DEPARTMENT OF STATE 2401 E ST. NW
WASHINGTON DC
20522-0001
US

IV. Provider business mailing address

US EMBASSY BOGOTA UNIT 5145
APO AA
34038
CO

V. Phone/Fax

Practice location:
  • Phone: 202-663-1662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31981
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number0101253037
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: