Healthcare Provider Details

I. General information

NPI: 1437799053
Provider Name (Legal Business Name): RUSSELL NEWKIRK III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-2423
US

IV. Provider business mailing address

BLDG #50, FARENHOLT AVE
AGANA HEIGHTS GU
96910
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4551
  • Fax:
Mailing address:
  • Phone: 671-344-9654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101273050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: