Healthcare Provider Details

I. General information

NPI: 1790103356
Provider Name (Legal Business Name): LAURA NEWCOMB HOMEWOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 LEE ST
CHARLOTTESVILLE VA
22908-9353
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-1955
  • Fax: 434-982-1841
Mailing address:
  • Phone:
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101269764
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: