Provider Demographics
NPI:1245564137
Name:NEWBILL, SEAN M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:M
Last Name:NEWBILL
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:P.O. BOX 40
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-0040
Mailing Address - Country:US
Mailing Address - Phone:419-732-1723
Mailing Address - Fax:419-734-0351
Practice Address - Street 1:611 FULTON STREET
Practice Address - Street 2:SUITE C
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2008
Practice Address - Country:US
Practice Address - Phone:419-732-6500
Practice Address - Fax:419-732-1512
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant