Provider Demographics
NPI:1528261302
Name:NEWMAN, ILANA MARA (MD)
Entity type:Individual
Prefix:DR
First Name:ILANA
Middle Name:MARA
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SE 3RD AVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2003
Mailing Address - Country:US
Mailing Address - Phone:877-868-4827
Mailing Address - Fax:877-283-0663
Practice Address - Street 1:3720 EXECUTIVE WAY STE 106
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3946
Practice Address - Country:US
Practice Address - Phone:877-868-4827
Practice Address - Fax:877-283-0663
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205825207QA0000X, 207QH0002X
FLME 92320207QA0000X
FLME92320207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279421700Medicaid