Provider Demographics
NPI:1962644120
Name:NEWSOM, WILLIAM ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:NEWSOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:924 N HOWE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-3038
Mailing Address - Country:US
Mailing Address - Phone:910-457-3806
Mailing Address - Fax:910-457-3842
Practice Address - Street 1:905 N HOWE ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461
Practice Address - Country:US
Practice Address - Phone:910-457-5657
Practice Address - Fax:910-457-0909
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC157128207R00000X
SC34353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1962644120OtherNPPES