Healthcare Provider Details

I. General information

NPI: 1053609594
Provider Name (Legal Business Name): JUSTIN PAUL NEWSTADT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HOAGIE DR
BEL AIR MD
21014-1884
US

IV. Provider business mailing address

4920 CAMPBELL BLVD
NOTTINGHAM MD
21236-5916
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4844
  • Fax: 410-893-3927
Mailing address:
  • Phone: 410-933-7600
  • Fax: 410-933-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD81153
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: