Healthcare Provider Details

I. General information

NPI: 1528261302
Provider Name (Legal Business Name): ILANA MARA NEWMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 EXECUTIVE WAY STE 106
MIRAMAR FL
33025-3946
US

IV. Provider business mailing address

123 SE 3RD AVE SUITE 460
MIAMI FL
33131-2003
US

V. Phone/Fax

Practice location:
  • Phone: 877-868-4827
  • Fax: 877-283-0663
Mailing address:
  • Phone: 877-868-4827
  • Fax: 877-283-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number205825
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberME 92320
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number205825
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME92320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: