Healthcare Provider Details

I. General information

NPI: 1902010432
Provider Name (Legal Business Name): MARY ROBERTA NEWBURGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PARSLEY CIR
SANTA FE NM
87506-9519
US

IV. Provider business mailing address

10 PARSLEY CIR
SANTA FE NM
87506-9519
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-1718
  • Fax: 505-989-1718
Mailing address:
  • Phone: 505-989-1718
  • Fax: 505-982-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGFE27273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: