Basic Information
| Provider Information | |||||||||
| NPI: | 1689617797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWTON | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23625 COMMERCE PARK | ||||||||
| Address2: | #204 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162555743 | ||||||||
| FaxNumber: | 8667353451 | ||||||||
| Practice Location | |||||||||
| Address1: | 2035 SILVERCREEK LN | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837066112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083680095 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 02/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | M7278 | ID | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0700X | M7278 | ID | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 223007100 | 05 | MD | MEDICAID | 2914252 | 05 | OH | MEDICAID | 804198300 | 05 | ID | MEDICAID | 1452114 | 05 | LA | MEDICAID | QM7278 | 05 | SC | MEDICAID | 1689617797 | 01 | TRICARE NORTH | OTHER |