Healthcare Provider Details

I. General information

NPI: 1134139975
Provider Name (Legal Business Name): ROGER W NEWSOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 ACADEMY AVE SUITE 200
PORTSMOUTH VA
23703-3200
US

IV. Provider business mailing address

1788 GREENSWARD QUAY
VIRGINIA BEACH VA
23454-1141
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-0400
  • Fax:
Mailing address:
  • Phone: 757-496-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101055448
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number0101055448
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: