Provider Demographics
NPI:1215955109
Name:NEWMAN, AHAN (MD)
Entity type:Individual
Prefix:
First Name:AHAN
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8426
Mailing Address - Country:US
Mailing Address - Phone:541-789-4096
Mailing Address - Fax:541-789-4073
Practice Address - Street 1:750 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8426
Practice Address - Country:US
Practice Address - Phone:541-789-4096
Practice Address - Fax:541-789-4073
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79783208000000X
ORMD150434208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD150434Medicaid
CA00A797830Medicare ID - Type Unspecified