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General NPI Number Information
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NPI Number | 1194733808
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Entity Type | Individual
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Provider Name | JOHN WATTS HARESCH MD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 6365 N CROATAN HWY SUITE B
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City | KITTY HAWK
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State | NC
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Zip | 27949-3800
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Country | US
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Telephone | 252-480-6631
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Fax | 252-480-6630
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Provider Business Mailing Address
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Address Line | 2401 E ST NW
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City | WASHINGTON
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State | DC
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Zip | 20225
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Country | US
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Telephone | 202-663-1718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200101152
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License Number State | NC
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