Healthcare Provider Details

I. General information

NPI: 1356576888
Provider Name (Legal Business Name): JOHANNA ROSE NEWTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 N LEBANON ST
LEBANON IN
46052-1476
US

IV. Provider business mailing address

2553 TWIN LAKES DR
CARMEL IN
46074-1106
US

V. Phone/Fax

Practice location:
  • Phone: 765-485-8500
  • Fax:
Mailing address:
  • Phone: 248-310-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01070334A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number01070334A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: