Healthcare Provider Details

I. General information

NPI: 1629194618
Provider Name (Legal Business Name): CHARLES EDWIN NEWMAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MILLS AVE
ORLANDO FL
32803-5736
US

IV. Provider business mailing address

444 N MILLS AVE
ORLANDO FL
32803-5736
US

V. Phone/Fax

Practice location:
  • Phone: 407-481-9505
  • Fax: 407-481-9506
Mailing address:
  • Phone: 407-481-9505
  • Fax: 407-481-9506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME98267
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number104466
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: