Provider Demographics
NPI:1174812655
Name:NEWMAN, JESSE A (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:A
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SULLIVAN TRL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8397
Mailing Address - Country:US
Mailing Address - Phone:610-250-8799
Mailing Address - Fax:610-258-1917
Practice Address - Street 1:1800 SULLIVAN TRL
Practice Address - Street 2:SUITE 201
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8397
Practice Address - Country:US
Practice Address - Phone:610-250-8799
Practice Address - Fax:610-258-1917
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD452516207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029805210001Medicaid
PA367515V8GMedicare PIN