Basic Information
Provider Information
NPI: 1881688398
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWTON
FirstName: EDWARD
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 751069
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282751069
CountryCode: US
TelephoneNumber: 2527443253
FaxNumber: 2527443194
Practice Location
Address1: 600 MOYE BLVD
Address2: ECU PHYSICIANS OBSTETRICS &GYNECOLOGY
City: GREENVILLE
State: NC
PostalCode: 278344300
CountryCode: US
TelephoneNumber: 2527442350
FaxNumber: 2527443098
Other Information
ProviderEnumerationDate: 09/12/2005
LastUpdateDate: 12/05/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VM0101X9800104NCY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine

ID Information
IDTypeStateIssuerDescription
1106V01NCBCBS NCOTHER
891106V05NC MEDICAID
16003818001NCRAILROAD MEDICAREOTHER


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