Provider Demographics
NPI:1043358666
Name:NEWBERRY OB GYN, P.A.
Entity type:Organization
Organization Name:NEWBERRY OB GYN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:803-276-4422
Mailing Address - Street 1:2520 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2940
Mailing Address - Country:US
Mailing Address - Phone:803-276-4422
Mailing Address - Fax:803-276-1592
Practice Address - Street 1:2520 EVANS ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2940
Practice Address - Country:US
Practice Address - Phone:803-276-4422
Practice Address - Fax:803-276-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0474207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1786Medicaid
SCGP1786Medicaid