Provider Demographics
NPI:1083708812
Name:NEWBROUGH, DAVID CHESTER (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHESTER
Last Name:NEWBROUGH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-0297
Mailing Address - Country:US
Mailing Address - Phone:252-357-1226
Mailing Address - Fax:252-357-1236
Practice Address - Street 1:102 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3361
Practice Address - Country:US
Practice Address - Phone:252-338-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100258363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100258OtherNC MEDICAL BOARD LICENSE
S53931Medicare UPIN