Healthcare Provider Details

I. General information

NPI: 1891765327
Provider Name (Legal Business Name): AUDREY RIKER NEWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MAIN ST
BAR HARBOR ME
04609-1648
US

IV. Provider business mailing address

1283 KING GEORGE BLVD
ANN ARBOR MI
48108-1771
US

V. Phone/Fax

Practice location:
  • Phone: 207-288-8604
  • Fax:
Mailing address:
  • Phone: 734-904-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301406995
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD22421
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: