Provider Demographics
NPI:1770697914
Name:NEWSOME, DENNIS C (PA-C)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:C
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 LINCOLN ST
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6279
Mailing Address - Country:US
Mailing Address - Phone:360-318-7512
Mailing Address - Fax:
Practice Address - Street 1:1329 LINCOLN ST
Practice Address - Street 2:SUITE # 3
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6279
Practice Address - Country:US
Practice Address - Phone:360-318-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004279363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB32735Medicare PIN
P-67192Medicare UPIN