Provider Demographics
NPI:1720071194
Name:NEWELL, LISA R (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:NEWELL
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 STAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-2503
Mailing Address - Country:US
Mailing Address - Phone:304-768-0321
Mailing Address - Fax:833-972-5595
Practice Address - Street 1:267 STAUNTON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-2503
Practice Address - Country:US
Practice Address - Phone:304-768-0321
Practice Address - Fax:833-972-5595
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001716590OtherBC/BS
WV286086OtherMAMSI AND OPTIMUM CHOICE
WV513906OtherRURAL HEALTH PROVIDER NO.
WV7655350OtherAETNA PIN
WV2003042000Medicaid
WV080188850OtherRAILROAD MEDICARE
WV4069571OtherMEDICARE
WV4069571OtherMEDICARE
WV513906OtherRURAL HEALTH PROVIDER NO.