Provider Demographics
NPI:1750502514
Name:NEW, RONNA DENISE (DO)
Entity Type:Individual
Prefix:
First Name:RONNA
Middle Name:DENISE
Last Name:NEW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RONNA
Other - Middle Name:DENISE
Other - Last Name:COMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-390-3339
Practice Address - Street 1:1 MEDICAL PARK BLVD STE 450W
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7470
Practice Address - Country:US
Practice Address - Phone:423-968-3713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203924207Q00000X, 207QG0300X
TN3315207Q00000X, 207QG0300X
KY03275207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750502514Medicaid
VAVVJ375AMedicare PIN