Basic Information
| Provider Information | |||||||||
| NPI: | 1093787699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWSOME | ||||||||
| FirstName: | BOBBETTE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1508 WILLOW LAWN DR | ||||||||
| Address2: | STE 117 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232303421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042888327 | ||||||||
| FaxNumber: | 8042823744 | ||||||||
| Practice Location | |||||||||
| Address1: | 1508 WILLOW LAWN DR | ||||||||
| Address2: | STE 117 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232303421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042888327 | ||||||||
| FaxNumber: | 8042823744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 08/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 0101030108 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | 0101030108 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 0101030108 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 0101030108 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | 0101030108 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085U0001X | 0101030108 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 224564 | 01 | VA | ANTHEM | OTHER | 1093787699 | 05 | VA | MEDICAID |