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General NPI Number Information
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NPI Number | 1891984274
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Entity Type | Organization
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Legal Business Name | CAROL L WATSON MD LLC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 140 HAZARD AVENUE SUITE 107
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City | ENFIELD
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State | CT
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Zip | 06082-4520
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Country | US
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Telephone | 860-749-4416
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Fax | 860-749-4506
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Provider Business Mailing Address
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Address Line | 140 HAZARD AVE SUITE 107
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City | ENFIELD
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State | CT
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Zip | 06082-4520
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Country | US
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Telephone | 860-749-4416
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Fax | 860-749-4506
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. DEBORAH L. BOUCHARD
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Credential |
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Telephone | 860-749-4416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 042373
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License Number State | CT
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