Provider Demographics
NPI:1932198843
Name:NEWCOMB, FREDERICK LEE JR (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LEE
Last Name:NEWCOMB
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 36351
Mailing Address - Street 2:SOUTHEAST ANESTHESIOLOGY CONSULTANTS PA
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6351
Mailing Address - Country:US
Mailing Address - Phone:704-377-5772
Mailing Address - Fax:704-377-3389
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-2372
Practice Address - Fax:704-355-6692
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC34224207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCM34224Medicaid
NC2160731Medicare PIN