Healthcare Provider Details

I. General information

NPI: 1144617424
Provider Name (Legal Business Name): JOHN THOMAS WATSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN THOMAS WATSON

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARTHA JEFFERSON DR
CHARLOTTESVILLE VA
22911-4668
US

IV. Provider business mailing address

500 MARTHA JEFFERSON DR
CHARLOTTESVILLE VA
22911-4668
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-5260
  • Fax: 844-340-9731
Mailing address:
  • Phone: 434-654-5260
  • Fax: 844-340-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101265862
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: