Provider Demographics
NPI:1306919311
Name:NEWSOME, TARA J (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:246 KY ROUTE 979
Practice Address - Street 2:
Practice Address - City:HAROLD
Practice Address - State:KY
Practice Address - Zip Code:41635-9046
Practice Address - Country:US
Practice Address - Phone:606-478-2200
Practice Address - Fax:866-310-9947
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY41205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100004770Medicaid
0601444Medicare PIN
0903683Medicare PIN
0745828Medicare PIN
0952013Medicare PIN
0771921Medicare PIN
KY7100004770Medicaid
0683241Medicare PIN
KYP00404551Medicare PIN
0935813Medicare PIN
0396859Medicare PIN
0935389Medicare PIN