Provider Demographics
NPI:1164464103
Name:WATT, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:WATT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:#450
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-224-6680
Mailing Address - Fax:410-224-4620
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:#450
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-224-6680
Practice Address - Fax:410-224-4620
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-04-10
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Provider Licenses
StateLicense IDTaxonomies
MDD40106207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150761300Medicaid
DC00A663R00Medicare PIN
MDKQ41LK93Medicare ID - Type Unspecified