Healthcare Provider Details

I. General information

NPI: 1689949653
Provider Name (Legal Business Name): CAROL L. WATSON, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W AVON RD SUITE D
AVON CT
06001-3678
US

IV. Provider business mailing address

601 CHAPEL AVE E SUITE B
CHERRY HILL NJ
08034-1454
US

V. Phone/Fax

Practice location:
  • Phone: 860-404-2137
  • Fax: 860-404-7204
Mailing address:
  • Phone: 856-356-4000
  • Fax: 856-414-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CARLSON
Title or Position: PROJECT MANAGER
Credential:
Phone: 856-356-4000