MEDICARE: DR. GEORGE H WATHEN MD PA

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	207R00000X	Internal Medicine Physician	D0020629	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110128523	OTHER		RR MEDICARE

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	:	1861453284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE H WATHEN MD PA

Provider Business Mailing Address
First Line	:	11345 PEMBROOKE SQ
Second Line	:	STE 103
City	:	WALDORF
State	:	MD
Zip	:	20603-4804
Country	:	US
Telephone Number	:	301-645-8144
Fax Number	:	301-870-8392

Provider Business Practice Location Address
First Line	:	11345 PEMBROOKE SQ
Second Line	:	SUITE 103
City	:	WALDORF
State	:	MD
Zip	:	20603-4804
Country	:	US
Telephone Number	:	301-645-8144
Fax Number	:	301-870-8392

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	02/15/2008

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Directions to “ DR. GEORGE H WATHEN MD PA” Practice Location

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