MEDICARE: DR. MARK THOMAS WATKINS DO

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	207QA0505X	Adult Medicine Physician	OS006195L	PA

General Provider Information

NPI Number	:	1336226166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK THOMAS WATKINS DO

Provider Business Mailing Address
First Line	:	253 S 10TH ST
Second Line	:	SUITE 201
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5751
Country	:	US
Telephone Number	:	215-829-0170
Fax Number	:	215-829-0173

Provider Business Practice Location Address
First Line	:	253 SO 10TH STREET
Second Line	:	SUITE 201
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5605
Country	:	US
Telephone Number	:	215-829-0170
Fax Number	:	215-829-0173

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/26/2009

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