Provider Demographics
NPI:1386972321
Name:NEWPORT, ANAMARIA (PA-C)
Entity type:Individual
Prefix:
First Name:ANAMARIA
Middle Name:
Last Name:NEWPORT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1908
Mailing Address - Country:US
Mailing Address - Phone:856-546-5353
Mailing Address - Fax:856-546-5315
Practice Address - Street 1:112 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1908
Practice Address - Country:US
Practice Address - Phone:856-546-5353
Practice Address - Fax:856-546-5315
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00229400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ219659VY2Medicare PIN