Individual
MARK A. NEWBROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
14732
WV
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
0101252865
VA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
40225
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000626574
MS BCBS
WV
05
—
0040799000
—
WV
01
—
4271801
AETNA
WV
Enumeration date
09/21/2006
Last updated
10/22/2020
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