Healthcare Provider Details

I. General information

NPI: 1689617797
Provider Name (Legal Business Name): DIANE R NEWTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 SILVERCREEK LN
BOISE ID
83706-6112
US

IV. Provider business mailing address

23625 COMMERCE PARK #204
BEACHWOOD OH
44122-5845
US

V. Phone/Fax

Practice location:
  • Phone: 208-368-0095
  • Fax:
Mailing address:
  • Phone: 216-255-5743
  • Fax: 866-735-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM7278
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberM7278
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: