Healthcare Provider Details

I. General information

NPI: 1780213314
Provider Name (Legal Business Name): MOLLIE NEWBERN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3503 SOUTHWEST BLVD
GROVE CITY OH
43123-3897
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 614-533-6140
  • Fax: 614-533-6141
Mailing address:
  • Phone: 501-955-2741
  • Fax: 501-955-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberE-19383
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34.017349
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: