Provider Demographics
NPI:1619907862
Name:JOHN G NEWBY MD P C
Entity Type:Organization
Organization Name:JOHN G NEWBY MD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-665-4901
Mailing Address - Street 1:1110 MEDICAL CAMPUS ROAD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742
Mailing Address - Country:US
Mailing Address - Phone:301-665-4901
Mailing Address - Fax:301-665-4941
Practice Address - Street 1:1110 MEDICAL CAMPUS ROAD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:301-665-4901
Practice Address - Fax:301-665-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK359OtherBLUE SHIELD
DCR511OtherBLUE SHIELD
DCR511OtherBLUE SHIELD
MDCA1738Medicare PIN