Provider Demographics
NPI:1326095290
Name:NEWBOLD, VIVIEN R (MD)
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:R
Last Name:NEWBOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 CORPORATE PARK DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3313
Mailing Address - Country:US
Mailing Address - Phone:513-924-5300
Mailing Address - Fax:513-351-3800
Practice Address - Street 1:8170 CORPORATE PARK DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3313
Practice Address - Country:US
Practice Address - Phone:513-924-5300
Practice Address - Fax:513-351-3800
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.064455208D00000X
OH35-06-4455207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000007422OtherANTHEM BCBS
OH000000185066OtherUNISON MEDICAID
OH930008466OtherRAILROAD MEDICARE
001714081OtherMOUNTAIN STATE BCBS
WV0044489000Medicaid
OH0897472OtherMOLINA MEDICAID
OH0897472Medicaid
OH310917085154OtherOH MEDICAID CARESOURCE
WV0044489000Medicaid
OH0730382Medicare PIN