Healthcare Provider Details

I. General information

NPI: 1609001114
Provider Name (Legal Business Name): KAREN FIONA WATTERS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVENUE DEPARTMENT OF OTOLARYNGOLOGY, CHILDRENS HOSPITAL BOSTON
BOSTON MA
02215
US

IV. Provider business mailing address

300 LONGWOOD AVE # LO-367 CHILDREN'S HOSPITAL BOSTON
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number249354
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number249354
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: