Provider Demographics
NPI:1083610760
Name:WATSON, AMINA T (MD)
Entity Type:Individual
Prefix:DR
First Name:AMINA
Middle Name:T
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WYMAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2803
Mailing Address - Country:US
Mailing Address - Phone:240-556-1000
Mailing Address - Fax:
Practice Address - Street 1:1700 SCIENCE DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:240-556-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057065208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB776-0016OtherBCBS DC
MD1851473722OtherGROUP NPI - MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
MD837102400Medicaid
MD1427093343OtherGROUP NPI - UPPER MARLBORO FAMILY MEDICAL CENTER
MD61795003OtherBCBS MD
MD61795003OtherBCBS MD
MD1427093343OtherGROUP NPI - UPPER MARLBORO FAMILY MEDICAL CENTER