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General NPI Number Information
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NPI Number | 1801898002
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Entity Type | Individual
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Provider Name | JARL THOMAS WATHNE M. D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 11110 MEDICAL CAMPUS RD STE 126
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City | HAGERSTOWN
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State | MD
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Zip | 21742-6799
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Country | US
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Telephone | 301-714-4375
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Fax | 301-714-4365
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Provider Business Mailing Address
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Address Line | 11110 MEDICAL CAMPUS RD STE 126
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City | HAGERSTOWN
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State | MD
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Zip | 21742-6799
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Country | US
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Telephone | 301-714-4375
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Fax | 301-714-4365
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | D0046383
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License Number State | MD
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