Provider Demographics
NPI:1669671376
Name:NEWSOM, JEFFREY W (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:NEWSOM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NORTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6069
Mailing Address - Country:US
Mailing Address - Phone:207-930-6708
Mailing Address - Fax:207-930-6709
Practice Address - Street 1:119 NORTHPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6069
Practice Address - Country:US
Practice Address - Phone:207-930-6708
Practice Address - Fax:207-930-6709
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD18352207Q00000X
ME018352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30209637Medicaid
ME001713101Medicare PIN
MEMM9086Medicare PIN