Healthcare Provider Details

I. General information

NPI: 1760424352
Provider Name (Legal Business Name): STANLEY WATKINS, JR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PKWY SUITE 210
ANNAPOLIS MD
21401-7992
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-5300
  • Fax:
Mailing address:
  • Phone: 443-481-6571
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD08118
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: