Basic Information
| Provider Information | |||||||||
| NPI: | 1225389893 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | E. THOMAS NEWBILL, MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12903 FOX MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | HENRICO | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232332270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042162187 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6900 FOREST AVE STE 115 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232301701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048938710 | ||||||||
| FaxNumber: | 8042851293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2012 | ||||||||
| LastUpdateDate: | 09/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | HOLTON | ||||||||
| AuthorizedOfficialFirstName: | EMMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8046432287 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0602X | 0101035155 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy |
No ID Information.