Provider Demographics
NPI:1063606150
Name:NEWTON, MARISHA T
Entity type:Individual
Prefix:
First Name:MARISHA
Middle Name:T
Last Name:NEWTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6481
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:G90
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:443-481-4600
Practice Address - Fax:443-481-3990
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443704207RE0101X, 207R00000X
MDD66426207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1603035OtherGATEWAY
PA2660608OtherHIGHMARK BLUE SHIELD
PA417545OtherUPMC
PA102639387Medicaid
PA2660608OtherHIGHMARK BLUE SHIELD
462259Y5ZMedicare PIN