MEDICARE: ALEXA RAE WATTS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1013647551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA RAE WATTS PA

Provider Business Mailing Address
First Line	:	7519 ANTOINETTE CT
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12303-5253
Country	:	US
Telephone Number	:	518-253-9058
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 CHILI AVE STE T1A
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-5452
Country	:	US
Telephone Number	:	585-571-2025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/16/2022

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