MEDICARE: LISA A WATSON 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	207Q00000X	Family Medicine Physician	OS014223	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689747297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA A WATSON DO

Provider Business Mailing Address
First Line	:	2314 SASSAFRAS STREET
Second Line	:	2ND FLOOR
City	:	ERIE
State	:	PA
Zip	:	16502-2721
Country	:	US
Telephone Number	:	814-452-5043
Fax Number	:	814-452-7005

Provider Business Practice Location Address
First Line	:	155 E STATE ST
Second Line	:
City	:	ALBION
State	:	PA
Zip	:	16401-1347
Country	:	US
Telephone Number	:	814-756-4917
Fax Number	:	814-756-5226

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	02/07/2024

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