1568423556 NPI number — SCOTT WATKINS MD PC

Table of content: (NPI 1568423556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568423556 NPI number — SCOTT WATKINS MD PC

Organization/Personal Information

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

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:
1568423556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12500 WILLOWBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-6393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-964-1480
Provider Business Mailing Address Fax Number:
240-964-1490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12500 WILLOWBROOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-6393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-964-1480
Provider Business Practice Location Address Fax Number:
240-964-1490
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WATKINS
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
VICTOR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
240-964-1480

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  D0062224 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0016490810001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0122100000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 941810501 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00274052 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002376161 . This is a "MARLYLAND PHYSICIANS CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: K906 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com