Healthcare Provider Details

I. General information

NPI: 1417064841
Provider Name (Legal Business Name): MATTHEW TODD NEWBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N LAKEMONT AVE STE 100
WINTER PARK FL
32792-3210
US

IV. Provider business mailing address

255 N LAKEMONT AVE STE 100
WINTER PARK FL
32792-3210
US

V. Phone/Fax

Practice location:
  • Phone: 407-490-1022
  • Fax: 407-490-1023
Mailing address:
  • Phone: 407-490-1022
  • Fax: 407-490-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME93532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: