Provider Demographics
NPI:1720046014
Name:NEWILL, CAROL ANN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:NEWILL
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6907 AVONDALE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1934
Mailing Address - Country:US
Mailing Address - Phone:410-769-8016
Mailing Address - Fax:
Practice Address - Street 1:6907 AVONDALE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1934
Practice Address - Country:US
Practice Address - Phone:410-769-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2023-03-07
Deactivation Date:2014-02-06
Deactivation Code:
Reactivation Date:2014-04-14
Provider Licenses
StateLicense IDTaxonomies
MDD44717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD44717OtherMEDICAL LICENSE
MDM39272OtherSTATE CDS NUMBER
MDM39272OtherSTATE CDS NUMBER