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General NPI Number Information
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NPI Number | 1902310626
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Entity Type | Organization
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Legal Business Name | NEWBOLD MEDICAL LLC
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 334 2ND AVE STE 1E
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1414
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Country | US
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Telephone | 740-208-5507
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Fax | 740-777-9609
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Provider Business Mailing Address
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Address Line | 509 GRAHAM SCHOOL RD
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City | GALLIPOLIS
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State | OH
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Zip | 45631-9133
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Country | US
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Telephone | 740-208-5507
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIVIEN NEWBOLD
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Credential | MD
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Telephone | 740-208-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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