Healthcare Provider Details

I. General information

NPI: 1851852149
Provider Name (Legal Business Name): MELANIE ALYSE WATMAN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 01/26/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 E PUTNAM AVE STE 2B
RIVERSIDE CT
06878-1426
US

IV. Provider business mailing address

1171 E PUTNAM AVE STE 2B
RIVERSIDE CT
06878-1426
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-6604
  • Fax: 203-629-7960
Mailing address:
  • Phone: 203-629-5800
  • Fax: 203-629-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number318100
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number73310
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: