MEDICARE: DR. DOUGLAS F. WATT PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	4125	MA

General Provider Information

NPI Number	:	1003816992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS F. WATT PH.D.

Provider Business Mailing Address
First Line	:	24 CHARLOTTE AVE
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03064-1551
Country	:	US
Telephone Number	:	508-740-0391
Fax Number	:	508-657-8605

Provider Business Practice Location Address
First Line	:	24 CHARLOTTE AVE
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03064-1551
Country	:	US
Telephone Number	:	508-740-0391
Fax Number	:	508-657-8605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/05/2016

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