Provider Demographics
NPI:1619976057
Name:NEWCOMBE, MARCIA JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:JEANNE
Last Name:NEWCOMBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15990 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4826
Mailing Address - Country:US
Mailing Address - Phone:248-849-4226
Mailing Address - Fax:248-849-4240
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:B233
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-4847
Practice Address - Fax:248-465-4809
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI418316010Medicaid
G13936Medicare UPIN
MI0F36485014Medicare ID - Type Unspecified