Provider Demographics
NPI:1962535666
Name:TODD NEWBERG MD PA
Entity type:Organization
Organization Name:TODD NEWBERG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:NEWBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-679-3400
Mailing Address - Street 1:5478 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1036
Mailing Address - Country:US
Mailing Address - Phone:407-679-3400
Mailing Address - Fax:407-679-3412
Practice Address - Street 1:5578 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1036
Practice Address - Country:US
Practice Address - Phone:407-679-3400
Practice Address - Fax:407-679-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1962535666OtherNPI ORGANIZATION