1912961681 NPI number — MICHELLE NEWSOM MPT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912961681 NPI number — MICHELLE NEWSOM MPT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NEWSOM

Provider First Name:

MICHELLE

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MPT

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1912961681

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/06/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1700 WILLOW LAWN DR

Provider Second Line Business Mailing Address:

STE 230

Provider Business Mailing Address City Name:

RICHMOND

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

23230-3003

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

804-340-1193

Provider Business Mailing Address Fax Number:

804-340-1930

Provider First Line Business Practice Location Address:

3805 CUTSHAW AVE

Provider Second Line Business Practice Location Address:

SUITE 299

Provider Business Practice Location Address City Name:

RICHMOND

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

23230

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

804-340-1193

Provider Business Practice Location Address Fax Number:

801-340-1930

Provider Enumeration Date:

04/12/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  2305203568 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 54960 . This is a "MEDICAID HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 184946 . This is a "ANTHEM PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 184946 . This is a "HEALTHKEEPERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 429180 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 183574 . This is a "ANTHEM PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 329180 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 412143526 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
• Identifier: 7630753 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 255534 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 6400713 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 7630753 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 6404543 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 143281 . This is a "AN/HK" identifier . This identifiers is of the category "OTHER".
• Identifier: 412143526 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".