MEDICARE: SAMUEL COLIN WATKINS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518473313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL COLIN WATKINS

Provider Business Mailing Address
First Line	:	401 12TH ST S
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-4226
Country	:	US
Telephone Number	:	206-595-3497
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 20TH ST NW STE 116
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-3406
Country	:	US
Telephone Number	:	202-416-2110
Fax Number	:

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

Provider Enumeration Date	:	12/17/2017
Last Update Date	:	12/29/2017

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