Healthcare Provider Details

I. General information

NPI: 1134205057
Provider Name (Legal Business Name): FREDERICK HARVEY WATKINS IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 TOWER OAKS BLVD #200
ROCKVILLE MD
20852
US

IV. Provider business mailing address

3203 TOWER OAKS BLVD #200
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-6398
  • Fax: 301-754-2503
Mailing address:
  • Phone: 301-656-6398
  • Fax: 301-754-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD0059925
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101234281
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD34146
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: