Provider Demographics
NPI:1669418034
Name:NEWCOMB, KATHLEEN LINDSAY (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LINDSAY
Last Name:NEWCOMB
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 7793
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120-7793
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2420 CAMINO RAMON
Practice Address - Street 2:STE 270
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4385
Practice Address - Country:US
Practice Address - Phone:925-543-0140
Practice Address - Fax:925-543-0145
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30498207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A304980Medicaid
CAA26131Medicare UPIN
CA00A304980Medicaid