Basic Information
| Provider Information | |||||||||
| NPI: | 1023092285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWCOMBE | ||||||||
| FirstName: | MALINDA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 S FISKE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329554306 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1220 N HIGHWAY A1A | ||||||||
| Address2: | SUITE 147 | ||||||||
| City: | INDIALANTIC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3215749031 | ||||||||
| FaxNumber: | 3219519127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME76872 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 260701800 | 05 | FL | MEDICAID | P01164160 | 01 | FL | FL RR MEDICARE | OTHER | 080153706 | 01 | FL | RR MEDICARE | OTHER | 49854Y | 01 | FL | FL MEDICARE | OTHER |