Provider Demographics
NPI:1215912258
Name:NEWTON, WILLIAM BROCKENBROUGH III (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BROCKENBROUGH
Last Name:NEWTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-0238
Mailing Address - Fax:
Practice Address - Street 1:770 HARTNESS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3376
Practice Address - Country:US
Practice Address - Phone:704-873-5594
Practice Address - Fax:704-871-9888
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-015502086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138CEMedicaid
NCNC0761Medicare PIN
I21407Medicare UPIN