Provider Demographics
NPI:1790763282
Name:NEWBOULD, SAMANTHA J (MD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:NEWBOULD
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:4112 HARBOUR POINTE BLVD SW
Practice Address - Street 2:STE 100
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5457
Practice Address - Country:US
Practice Address - Phone:425-347-6330
Practice Address - Fax:425-347-6335
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24750207Q00000X
TXP1479207Q00000X
WAMD60611291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX294832501Medicaid
OR297480Medicaid
TX294832502Medicaid
TXTXB145787Medicare PIN
TX294832502Medicaid
TXTXB145269Medicare PIN
OR297480Medicaid
WAG8947587Medicare UPIN