Healthcare Provider Details

I. General information

NPI: 1407938921
Provider Name (Legal Business Name): ROGER ALAN WATKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4374 NEW TOWN AVE SUITE 102
WILLIAMSBURG VA
23188-2865
US

IV. Provider business mailing address

4374 NEW TOWN AVE SUITE 102
WILLIAMSBURG VA
23188-2865
US

V. Phone/Fax

Practice location:
  • Phone: 757-259-6770
  • Fax: 757-259-6794
Mailing address:
  • Phone: 757-259-6770
  • Fax: 757-259-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101039928
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: