Provider Demographics
NPI:1912004649
Name:NEWCOM, BRADLY C (MD)
Entity Type:Individual
Prefix:
First Name:BRADLY
Middle Name:C
Last Name:NEWCOM
Suffix:
Gender:M
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 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:510 RUBY DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2168
Practice Address - Country:US
Practice Address - Phone:270-399-7900
Practice Address - Fax:270-399-7910
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39210207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000362048OtherBCBS PROVIDER NUMBER
KY64098379Medicaid
KY39210OtherLICENSE
000000362048OtherBCBS PROVIDER NUMBER
KYP00319944Medicare PIN
0935321Medicare PIN
KY39210OtherLICENSE
KY64098379Medicaid