Provider Demographics
NPI:1528193786
Name:NEWCOMB, KATHERINE RENEE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RENEE
Last Name:NEWCOMB
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:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:CA
Mailing Address - Zip Code:95321-1126
Mailing Address - Country:US
Mailing Address - Phone:209-962-4611
Mailing Address - Fax:209-962-5860
Practice Address - Street 1:21340 BEAVER CT
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:CA
Practice Address - Zip Code:95321-9504
Practice Address - Country:US
Practice Address - Phone:209-962-4611
Practice Address - Fax:209-962-5860
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE91031Medicare UPIN