1558343152 NPI number — BRIAN PATRICK WATKINS MD

Table of content: BRIAN PATRICK WATKINS MD (NPI 1558343152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558343152 NPI number — BRIAN PATRICK WATKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATKINS
Provider First Name:
BRIAN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558343152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 LINDEN OAKS
Provider Second Line Business Mailing Address:
SUITE #300
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14625-2814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-383-8830
Provider Business Mailing Address Fax Number:
585-383-8918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 DRIVING PARK AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14513-1090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-359-2670
Provider Business Practice Location Address Fax Number:
315-359-2675
Provider Enumeration Date:
11/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  42614 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 239602 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)