Provider Demographics
NPI:1871767459
Name:NEWMAN, MARK W (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:223 BULIFANTS BLVD STE C
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5734
Practice Address - Country:US
Practice Address - Phone:757-258-2561
Practice Address - Fax:757-258-5936
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2020-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102037017208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005707919Medicaid
VA322590OtherANTHEM
VAE29953Medicare UPIN
VA050001191Medicare PIN