Provider Demographics
NPI:1902310626
Name:NEWBOLD MEDICAL LLC
Entity Type:Organization
Organization Name:NEWBOLD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-208-5507
Mailing Address - Street 1:509 GRAHAM SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-9133
Mailing Address - Country:US
Mailing Address - Phone:740-208-5507
Mailing Address - Fax:
Practice Address - Street 1:334 2ND AVE STE 1E
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1414
Practice Address - Country:US
Practice Address - Phone:740-208-5507
Practice Address - Fax:740-777-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35.064455OtherOHIO