Basic Information
| Provider Information | |||||||||
| NPI: | 1285939579 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWPORT FAMILY PRACTICE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 RED HILL CT | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170748706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175673151 | ||||||||
| FaxNumber: | 7175677571 | ||||||||
| Practice Location | |||||||||
| Address1: | 52 RED HILL CT | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170748706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175673151 | ||||||||
| FaxNumber: | 7175677571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 09/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | SAUSMAN | ||||||||
| AuthorizedOfficialFirstName: | LOUISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7175673151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.