Provider Demographics
NPI:1104111426
Name:NEWSOM, KRISTEN ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:NEWSOM
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 1:64 BOYDEN RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2570
Mailing Address - Country:US
Mailing Address - Phone:508-829-6765
Mailing Address - Fax:508-829-1884
Practice Address - Street 1:64 BOYDEN RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-2570
Practice Address - Country:US
Practice Address - Phone:508-829-6765
Practice Address - Fax:508-829-1884
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258099207Q00000X
RILP02152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine