Provider Demographics
NPI:1689018228
Name:LARS R. NEWSOME, M.D., INC.
Entity Type:Organization
Organization Name:LARS R. NEWSOME, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARS
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-429-6290
Mailing Address - Street 1:4130 LA JOLLA VILLAGE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1481
Mailing Address - Country:US
Mailing Address - Phone:858-429-6290
Mailing Address - Fax:858-244-0152
Practice Address - Street 1:4130 LA JOLLA VILLAGE DR STE 300
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1481
Practice Address - Country:US
Practice Address - Phone:858-429-6290
Practice Address - Fax:858-244-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42281207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50764Medicare UPIN