Provider Demographics
NPI:1821011925
Name:NEWELL, BEATRICE O (MD)
Entity Type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:O
Last Name:NEWELL
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 1:638 E COLLEGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-2363
Mailing Address - Country:US
Mailing Address - Phone:606-318-3500
Mailing Address - Fax:606-318-3503
Practice Address - Street 1:638 E COLLEGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2363
Practice Address - Country:US
Practice Address - Phone:606-318-3500
Practice Address - Fax:606-318-3503
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23144208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100246960Medicaid
AL009937581Medicaid
MS04788846Medicaid
MS04788846Medicaid