Provider Demographics
NPI:1750064101
Name:NEWPORT DERMATOLOGY CLINIC, PLLC
Entity type:Organization
Organization Name:NEWPORT DERMATOLOGY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:FORBSON
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DMSC, PA-C
Authorized Official - Phone:910-545-6901
Mailing Address - Street 1:24 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-3728
Mailing Address - Country:US
Mailing Address - Phone:910-545-6901
Mailing Address - Fax:
Practice Address - Street 1:285 HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-7927
Practice Address - Country:US
Practice Address - Phone:252-223-4054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty