Healthcare Provider Details

I. General information

NPI: 1619939907
Provider Name (Legal Business Name): DEBORAH WATSON FITZPATRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH WATSON M.D.

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 100
COLUMBIA MD
21045-3263
US

IV. Provider business mailing address

6400 SHAFER CT STE 700
ROSEMONT IL
60018-4989
US

V. Phone/Fax

Practice location:
  • Phone: 410-689-7400
  • Fax:
Mailing address:
  • Phone: 346-376-1702
  • Fax: 224-532-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD59736
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: