Provider Demographics
NPI:1871517508
Name:NEWBERG, CATHLEEN R (PT)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:R
Last Name:NEWBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 DEMOCRACY BLVD STE 504
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1166
Mailing Address - Country:US
Mailing Address - Phone:301-607-9096
Mailing Address - Fax:410-848-3909
Practice Address - Street 1:6707 DEMOCRACY BLVD STE 504
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1166
Practice Address - Country:US
Practice Address - Phone:301-607-9096
Practice Address - Fax:410-848-3909
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15670225100000X
WV002178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKBC4H0-65049301OtherBC/BS OF MARYLAND
MDS404-0026OtherCAREFIRST BC/BS
MDMD167MN874Medicare ID - Type UnspecifiedFREDERICK CO