Healthcare Provider Details

I. General information

NPI: 1174985915
Provider Name (Legal Business Name): CHRISTOPHER IAN NEWBERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

148 W RIVER ST STE 2A
PROVIDENCE RI
02904-2615
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6162
  • Fax:
Mailing address:
  • Phone: 314-454-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD18494
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberMD18494
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: