Provider Demographics
NPI:1932562667
Name:NEWSOME, HILLARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:HILLARY
Middle Name:ANN
Last Name:NEWSOME
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 1:660 S EUCLID
Mailing Address - Street 2:CAMPUS BOX 8115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-8060
Mailing Address - Country:US
Mailing Address - Phone:142-733-4985
Mailing Address - Fax:314-362-9101
Practice Address - Street 1:1044 N MASON RD STE L10
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6687
Practice Address - Country:US
Practice Address - Phone:314-996-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021009791207Y00000X
CT071529207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200095085Medicaid