Provider Demographics
NPI:1104890821
Name:NEWMAN, BEVERLEY (MD)
Entity type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEVERLEY
Other - Middle Name:
Other - Last Name:MICHELOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:725 WELCH RD
Mailing Address - Street 2:LUCILE PACKARD CHILDREN'S HOSPITAL, RADIOLOGY
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-497-8000
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:LUCILE PACKARD CHILDREN'S HOSPITAL, RADIOLOGY
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC524072085R0202X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000987656Medicaid
PA000987656Medicaid
PAC30039Medicare UPIN