Provider Demographics
NPI:1083063895
Name:NEWINGHAM, NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NEWINGHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5393
Mailing Address - Country:US
Mailing Address - Phone:215-361-5010
Mailing Address - Fax:215-362-3414
Practice Address - Street 1:225 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-5221
Practice Address - Country:US
Practice Address - Phone:215-441-6650
Practice Address - Fax:215-441-6830
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine