Healthcare Provider Details

I. General information

NPI: 1255246146
Provider Name (Legal Business Name): JOHN THOMAS WATSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 ERDMAN AVE
BALTIMORE MD
21213-1126
US

IV. Provider business mailing address

2616 ERDMAN AVE
BALTIMORE MD
21213-1126
US

V. Phone/Fax

Practice location:
  • Phone: 443-857-6610
  • Fax: 410-439-9604
Mailing address:
  • Phone: 443-857-6610
  • Fax: 410-439-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAL-00969
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: