Healthcare Provider Details

I. General information

NPI: 1801056833
Provider Name (Legal Business Name): KEITH EDWARD NEWBROUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KINGSLEY LN STE 305
NORFOLK VA
23505-4614
US

IV. Provider business mailing address

110 KINGSLEY LN STE 305
NORFOLK VA
23505-4614
US

V. Phone/Fax

Practice location:
  • Phone: 757-889-5942
  • Fax: 757-889-5450
Mailing address:
  • Phone: 757-889-5942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01066433A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number11013608A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101251332
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: