Healthcare Provider Details

I. General information

NPI: 1962499921
Provider Name (Legal Business Name): KEITH M NEWMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WEST PIKE ST SUITE 200
CLARKSBURG WV
26301-2629
US

IV. Provider business mailing address

700 WEST PIKE ST SUITE 200
CLARKSBURG WV
26301-2629
US

V. Phone/Fax

Practice location:
  • Phone: 304-624-6821
  • Fax: 304-624-6840
Mailing address:
  • Phone: 304-624-6821
  • Fax: 304-624-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberWV00232
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: