Healthcare Provider Details

I. General information

NPI: 1063413961
Provider Name (Legal Business Name): THOMAS RAYMOND NEUMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 NILES CORTLAND RD NE
WARREN OH
44484-1941
US

IV. Provider business mailing address

349 NILES CORTLAND RD NE
WARREN OH
44484-1941
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-2957
  • Fax: 330-856-1615
Mailing address:
  • Phone: 330-856-2957
  • Fax: 330-856-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35-07-0416-N
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberND058750L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG67510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: