=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720263684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEITH M NEWMAN, DPM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2008
-----------------------------------------------------
Last Update Date | 03/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 W PIKE ST SUITE 200
-----------------------------------------------------
City | CLARKSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26301-2629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-624-6821
-----------------------------------------------------
Fax | 304-624-6840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 W PIKE ST SUITE 200
-----------------------------------------------------
City | CLARKSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26301-2629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-624-6821
-----------------------------------------------------
Fax | 304-624-6840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JOHN R FERGUSON JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-624-6821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 00232
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------