Provider Demographics
NPI:1144587262
Name:NEWSOME, ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19760 SOUTH LAKESHORE BLVD.
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1151
Mailing Address - Country:US
Mailing Address - Phone:216-905-9219
Mailing Address - Fax:
Practice Address - Street 1:27900 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3539
Practice Address - Country:US
Practice Address - Phone:216-731-7110
Practice Address - Fax:216-731-7130
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003508363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070303Medicaid
OHH091110Medicare PIN