Provider Demographics
NPI:1184685646
Name:WATSON, SUSAN AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:AUSTIN
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 1:512 SHADY CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-1715
Mailing Address - Country:US
Mailing Address - Phone:252-231-0424
Mailing Address - Fax:252-231-0580
Practice Address - Street 1:11081 FOREST PINES DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7655
Practice Address - Country:US
Practice Address - Phone:252-231-0424
Practice Address - Fax:252-231-0580
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30512207W00000X
VA0101039474207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86013OtherBCBS
NC8986013Medicaid
NC8986013Medicaid
NC86013OtherBCBS