Provider Demographics
NPI:1598925943
Name:NEWCOMER, GEORGE R (CRNP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:R
Last Name:NEWCOMER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 N READING RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9802
Mailing Address - Country:US
Mailing Address - Phone:717-733-6546
Mailing Address - Fax:
Practice Address - Street 1:446 N READING RD
Practice Address - Street 2:SUITE 301
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9802
Practice Address - Country:US
Practice Address - Phone:717-733-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028958600001Medicaid
PA177990R1XOtherMEDICARE