Healthcare Provider Details

I. General information

NPI: 1497738967
Provider Name (Legal Business Name): DEAN WATZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 3RD ST
BEAVER PA
15009-2530
US

IV. Provider business mailing address

1201 3RD ST
BEAVER PA
15009-2530
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-2942
  • Fax: 724-770-7943
Mailing address:
  • Phone: 724-774-2942
  • Fax: 724-770-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD433208
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD433208
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: