Basic Information
| Provider Information | |||||||||
| NPI: | 1497884993 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEW | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376620009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238572066 | ||||||||
| FaxNumber: | 4238572070 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | ABINGDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242109700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766763870 | ||||||||
| FaxNumber: | 2766288927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 03/01/2017 | ||||||||
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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 | 207N00000X | 0101257093 | VA | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 43422 | KY | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 49741 | TN | N | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | P00847185 | 01 | RR MEDICARE | OTHER | P01582842 | 01 | VA | RAILROAD MEDICARE | OTHER | P01554204 | 01 | VA | RR MEDICARE | OTHER | 9492505 | 01 | AETNA | OTHER | 7100121390 | 05 | KY | MEDICAID |