MEDICARE: TERRY WATKIN 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	174400000X	Specialist	010104747	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	130018728	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4571 0003	OTHER	DC	CF BC BS DC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0500138	OTHER	VA	UNITED HEALTHCARE
4	244468	OTHER	VA	ANTHEM
5	283590	OTHER	VA	AMERIGROUP
6	4053661	OTHER	VA	AETNA
7	535088 02	OTHER	MD	CF BC BS MD/NASCO
8	85488	OTHER	VA	MAMSI/ALLIANCE
10	505096	OTHER	VA	NCPPO

General Provider Information

NPI Number	:	1043315369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY WATKIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 79429
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-0429
Country	:	US
Telephone Number	:	301-624-5730
Fax Number	:	301-624-5731

Provider Business Practice Location Address
First Line	:	12007 SUNRISE VALLEY DR
Second Line	:	SUITE 120
City	:	RESTON
State	:	VA
Zip	:	20191-3479
Country	:	US
Telephone Number	:	301-624-5730
Fax Number	:	301-624-5731

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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Directions to “ TERRY WATKIN M.D.” Practice Location

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