Basic Information
| Provider Information | |||||||||
| NPI: | 1881620268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWELL | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 FRANKLIN ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067061253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037096000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 95 SCOVILL ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067061113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037096000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 043504 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 043504 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 043504 | 01 | CT | CONNECTICARE | OTHER | 24-23956 | 01 | CT | AMERICHOICE | OTHER | 24-23956 | 01 | CT | UHC | OTHER | PENDING | 01 | CT | RR MEDICARE | OTHER | 2V6984 | 01 | CT | HEALTHNET/COMMERCIAL | OTHER | 001435040 | 05 | CT | MEDICAID | 3957856/7909676 | 01 | CT | AETNA | OTHER | P3632834 | 01 | CT | OXFORD | OTHER | 010043504CT02 | 01 | CT | ANTHEM BCBS CT | OTHER | 974022 | 01 | CT | USA | OTHER | 246269 | 01 | CT | WELLCARE | OTHER |