Healthcare Provider Details

I. General information

NPI: 1639699051
Provider Name (Legal Business Name): ROSS WATSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 CAMPUS AVE
LEWISTON ME
04240-6030
US

IV. Provider business mailing address

235 NEWELL BROOK RD
DURHAM ME
04222-5342
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-8100
  • Fax:
Mailing address:
  • Phone: 207-740-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number84336
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD22947
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: