Healthcare Provider Details

I. General information

NPI: 1063606150
Provider Name (Legal Business Name): MARISHA T NEWTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PKWY G90
ANNAPOLIS MD
21401-7992
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-4600
  • Fax: 443-481-3990
Mailing address:
  • Phone: 443-481-6481
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD443704
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD443704
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD66426
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: