Provider Demographics
NPI:1578630216
Name:NEWSOME, VERONICA KIM (DO)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:KIM
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:DO
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 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-371-2197
Mailing Address - Fax:814-371-4837
Practice Address - Street 1:865 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2511
Practice Address - Country:US
Practice Address - Phone:814-371-2197
Practice Address - Fax:814-371-4837
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013742207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101731049001Medicaid
PA101731049001Medicaid
PA109021Medicare PIN