MEDICARE: DARYL C WATSON 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	207R00000X	Internal Medicine Physician	MD050257L	PA
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	MD050257L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD050257L	OTHER	PA	MEDICAL LISCENSE NUMBER

General Provider Information

NPI Number	:	1912926718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL C WATSON M.D.

Provider Business Mailing Address
First Line	:	9150 MARSHALL ST STE 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2217
Country	:	US
Telephone Number	:	215-464-4450
Fax Number	:	215-464-0445

Provider Business Practice Location Address
First Line	:	9150 MARSHALL ST STE 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2217
Country	:	US
Telephone Number	:	215-464-4450
Fax Number	:	215-464-0445

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/18/2022

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