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General NPI Number Information
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NPI Number | 1275707671
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Entity Type | Organization
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Legal Business Name | TRIANGLE MEDICAL, INC.
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1202 LOCUST ST SUITE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5605
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Country | US
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Telephone | 215-545-0170
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Fax | 215-545-8677
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Provider Business Mailing Address
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Address Line | 1202 LOCUST ST SUITE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5605
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Country | US
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Telephone | 215-545-0170
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Fax | 215-545-8677
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MARK T WATKINS
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Credential | D.O.
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Telephone | 215-545-0170
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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 | OS006195-L
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License Number State | PA
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