Provider Demographics
NPI:1417060260
Name:NEWLAND, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:NEWLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2766
Mailing Address - Country:US
Mailing Address - Phone:843-549-9500
Mailing Address - Fax:843-549-6885
Practice Address - Street 1:459 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2766
Practice Address - Country:US
Practice Address - Phone:843-549-9500
Practice Address - Fax:843-549-6885
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17365207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC173653Medicaid
SC180035684OtherRAILROAD MEDICARE
SC5909Medicare PIN
SC173653Medicaid
SC5910Medicare PIN
SCF85492Medicare UPIN
SC5912Medicare PIN