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General NPI Number Information
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NPI Number | 1225491160
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Entity Type | Individual
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Provider Name | CANDACE SUMMER WATTS MD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 632 BROADWAY PH
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City | NEW YORK
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State | NY
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Zip | 10012-2614
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Country | US
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Telephone | 800-731-4254
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 MOUNTAIN ROAD PL NE STE 5174
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7845
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 151459
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60852613
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0074500
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD20221408
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License Number State | NM
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