Healthcare Provider Details

I. General information

NPI: 1154613628
Provider Name (Legal Business Name): CYNTHIA MCCARTY NEWBERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF UT ANESTHESIOLOGY DEPARTMENT 50 N MEDICAL DRIVE
SALT LAKE CITY UT
84132-0100
US

IV. Provider business mailing address

U-U ANESTHESIOLOGY DEPARTMENT SCHOOL OF MEDICINE PO BOX 413034
SALT LAKE CITY UT
84141-3034
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8138637-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: