Provider Demographics
NPI:1609809623
Name:NEWBY, KEITH SR (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:NEWBY
Suffix:SR
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:PO BOX 639971
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9971
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 W 21ST ST FL 2
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1516
Practice Address - Country:US
Practice Address - Phone:757-483-3030
Practice Address - Fax:757-484-7239
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051954207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005825229Medicaid
VAA103567OtherINDIVIDUAL PTAN
VAF74198Medicare UPIN
VA060000930Medicare ID - Type Unspecified