Provider Demographics
NPI:1356300321
Name:NEWBOLD, MEGAN L (PA)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:L
Last Name:NEWBOLD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3674 ROUTE 27
Mailing Address - Street 2:PRINCETON RADIOLOGY ASSOCIATES, P.A., DEPARTMENT B
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-821-5563
Mailing Address - Fax:732-821-6675
Practice Address - Street 1:3674 ROUTE 27
Practice Address - Street 2:PRINCETON RADIOLOGY ASSOCIATES, P.A. DEPARTMENT B
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824
Practice Address - Country:US
Practice Address - Phone:732-821-5563
Practice Address - Fax:732-821-6675
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00111300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077294Medicare ID - Type Unspecified
Q15758Medicare UPIN