Provider Demographics
NPI:1700085313
Name:NEWGENT, KELLY JD (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JD
Last Name:NEWGENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10901 W TOLLER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6312
Mailing Address - Country:US
Mailing Address - Phone:303-973-3200
Mailing Address - Fax:303-904-8510
Practice Address - Street 1:10901 W TOLLER DR STE 101
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6312
Practice Address - Country:US
Practice Address - Phone:303-973-3200
Practice Address - Fax:303-904-8510
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48963208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12223352Medicaid
COCOA102028Medicare PIN