Basic Information
| Provider Information | |||||||||
| NPI: | 1346248101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWBILL | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12903 FOX MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | HENRICO | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232332270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044843700 | ||||||||
| FaxNumber: | 8043230770 | ||||||||
| Practice Location | |||||||||
| Address1: | 6900 FOREST AVE STE 115 | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232301701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048938710 | ||||||||
| FaxNumber: | 8042851293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 09/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0602X | 0101035155 | VA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy |
ID Information
| ID | Type | State | Issuer | Description | 6501346 | 05 | VA | MEDICAID |