MEDICARE: DR. COLLEEN M WATKINS 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	207RR0500X	Rheumatology Physician	21573	WV

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

General Provider Information

NPI Number	:	1689781205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN M WATKINS M. D.

Provider Business Mailing Address
First Line	:	P. O. BOX 897
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26507-0897
Country	:	US
Telephone Number	:	304-293-7401
Fax Number	:	304-293-6963

Provider Business Practice Location Address
First Line	:	1 STADIUM DRIVE
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26507
Country	:	US
Telephone Number	:	304-598-4830
Fax Number	:	304-293-6963

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	04/08/2022

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