Provider Demographics
NPI:1215040928
Name:ROCKWELL PHYSICIANS OF SALISBURY
Entity Type:Organization
Organization Name:ROCKWELL PHYSICIANS OF SALISBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:WATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-897-6140
Mailing Address - Street 1:2410 PAGEHURST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6411
Mailing Address - Country:US
Mailing Address - Phone:804-897-6140
Mailing Address - Fax:804-897-6141
Practice Address - Street 1:2410 PAGEHURST DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6411
Practice Address - Country:US
Practice Address - Phone:804-897-6140
Practice Address - Fax:804-897-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052275207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70772Medicare UPIN