Healthcare Provider Details

I. General information

NPI: 1194883785
Provider Name (Legal Business Name): ANDREW WATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/25/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 CENTRE AVE D380
PITTSBURGH PA
15232-1309
US

IV. Provider business mailing address

497 SCAIFE HALL 3550 TERRACE STREET
PITTSBURGH PA
15261-0001
US

V. Phone/Fax

Practice location:
  • Phone: 412-623-4861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD070687
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: