Provider Demographics
NPI:1083896088
Name:WATSON, COLLIN C (MD)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:C
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4233
Mailing Address - Country:US
Mailing Address - Phone:203-479-3600
Mailing Address - Fax:203-479-3601
Practice Address - Street 1:500 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4233
Practice Address - Country:US
Practice Address - Phone:203-479-3600
Practice Address - Fax:203-479-3601
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine