Provider Demographics
NPI:1548731763
Name:NEWBERG, MICHAEL ROBERT
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:NEWBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45298 STARK DR
Mailing Address - Street 2:
Mailing Address - City:PINEY POINT
Mailing Address - State:MD
Mailing Address - Zip Code:20674-3023
Mailing Address - Country:US
Mailing Address - Phone:301-994-0437
Mailing Address - Fax:
Practice Address - Street 1:29675 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-5240
Practice Address - Country:US
Practice Address - Phone:301-884-4635
Practice Address - Fax:301-884-8937
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06718235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist