MEDICARE: KRISTEN ELIZABETH NEWSOM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	258099	MA
2	207Q00000X	Family Medicine Physician	LP02152	RI

General Provider Information

NPI Number	:	1104111426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN ELIZABETH NEWSOM M.D.

Provider Business Mailing Address
First Line	:	64 BOYDEN RD
Second Line	:
City	:	HOLDEN
State	:	MA
Zip	:	01520-2570
Country	:	US
Telephone Number	:	508-829-6765
Fax Number	:	508-829-1884

Provider Business Practice Location Address
First Line	:	64 BOYDEN RD
Second Line	:
City	:	HOLDEN
State	:	MA
Zip	:	01520-2570
Country	:	US
Telephone Number	:	508-829-6765
Fax Number	:	508-829-1884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	12/15/2014

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