Provider Demographics
NPI:1548212780
Name:NEWELL, REBECCA T (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:T
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2720 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4810
Mailing Address - Country:US
Mailing Address - Phone:803-791-2365
Mailing Address - Fax:803-791-2392
Practice Address - Street 1:2720 SUNSET BLVD.
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-791-2365
Practice Address - Fax:803-791-2392
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC123592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE11232Medicare UPIN