MEDICARE: DR. LAWRENCE BERNARD WATKINS M.D.

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	208000000X	Pediatrics Physician	35046248W	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457431140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE BERNARD WATKINS M.D.

Provider Business Mailing Address
First Line	:	6335 ALISSA LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3456
Country	:	US
Telephone Number	:	614-755-9194
Fax Number	:	614-755-9846

Provider Business Practice Location Address
First Line	:	3433 AGLER RD
Second Line	:	SUITE 1300
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3387
Country	:	US
Telephone Number	:	614-755-9194
Fax Number	:	614-476-8748

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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