MEDICARE: DR. ABDUL R. WATTAR M.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	207RC0000X	Cardiovascular Disease Physician	35065300	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00136360	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000331560	OTHER	OH	ANTHEM
2	341221800122	OTHER	OH	CARESOURCE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	F65300	OTHER	OH	SUMMACARE

General Provider Information

NPI Number	:	1013996214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABDUL R. WATTAR M.D.

Provider Business Mailing Address
First Line	:	2830 VICTORY PKWY
Second Line	:	CENTRAL CREDENTIALING
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1785
Country	:	US
Telephone Number	:	513-245-3669
Fax Number	:	513-475-7259

Provider Business Practice Location Address
First Line	:	7700 UNIVERSITY CT
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6542
Country	:	US
Telephone Number	:	513-867-3331
Fax Number	:	513-867-2667

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	06/27/2011

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Directions to “ DR. ABDUL R. WATTAR M.D.” Practice Location

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