Basic Information
| Provider Information | |||||||||
| NPI: | 1356390694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWMAN | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | SANTOS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284248 | ||||||||
| FaxNumber: | 3178658314 | ||||||||
| Practice Location | |||||||||
| Address1: | 8865 W 400 N | ||||||||
| Address2: | SUITE 175 | ||||||||
| City: | MICHIGAN CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198772225 | ||||||||
| FaxNumber: | 2198772230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 1043773 | IN | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200043300A | 05 | IN | MEDICAID | 1043773 | 01 | IN | MEDICAL LICENSE | OTHER |