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General NPI Number Information
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NPI Number | 1942008073
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Entity Type | Individual
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Provider Name | DWIGHT NEWBY IV MD
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Gender | Male
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 1720 BRIGHTSEAT RD
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City | LANDOVER
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State | MD
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Zip | 20785-3777
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Country | US
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Telephone | 833-962-0481
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Fax | 415-555-0132
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Provider Business Mailing Address
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Address Line | 1720 BRIGHTSEAT RD
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City | LANDOVER
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State | MD
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Zip | 20785-3777
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Country | US
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Telephone | 833-962-0481
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Fax | 415-555-0132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 103G004567A
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License Number State | MD
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