Healthcare Provider Details

I. General information

NPI: 1346248101
Provider Name (Legal Business Name): EDWARD THOMAS NEWBILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 FOREST AVE STE 115 SUITE 303
RICHMOND VA
23230-1701
US

IV. Provider business mailing address

12903 FOX MEADOW DR
HENRICO VA
23233-2270
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-8710
  • Fax: 804-285-1293
Mailing address:
  • Phone: 804-484-3700
  • Fax: 804-323-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number0101035155
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: