Provider Demographics
NPI:1033122668
Name:WATSON, MARIA JEANETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:JEANETTE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2002 N CEDAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3926
Mailing Address - Country:US
Mailing Address - Phone:910-272-3048
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:1249 CHICKEN FOOT RD
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-7525
Practice Address - Country:US
Practice Address - Phone:910-423-1278
Practice Address - Fax:910-423-2547
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900715207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1202YOtherBLUE CROSS BLUE SHIELD
NC891202YMedicaid
NC891202YMedicaid
NC891202YMedicaid