Provider Demographics
NPI:1396968483
Name:NEWCOMB, GWYNETH WAGNER (AUD)
Entity type:Individual
Prefix:DR
First Name:GWYNETH
Middle Name:WAGNER
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 SUPERIOR LN
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1920
Mailing Address - Country:US
Mailing Address - Phone:301-464-6701
Mailing Address - Fax:301-464-8217
Practice Address - Street 1:3233 SUPERIOR LN
Practice Address - Street 2:SUITE B-2
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1920
Practice Address - Country:US
Practice Address - Phone:301-464-6701
Practice Address - Fax:301-464-8217
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00382237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD204578Medicare ID - Type UnspecifiedAUDIOLOGIST