Provider Demographics
NPI:1932351764
Name:NEWSOM, KENT J (DO)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:J
Last Name:NEWSOM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:1 SCIENCE CT STE 200
Practice Address - Street 2:PROFESSIONAL PATHOLOGY SERVICES
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9653
Practice Address - Country:US
Practice Address - Phone:866-252-1913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39793207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016304800Medicaid
FLIK107ZMedicare PIN