Provider Demographics
NPI:1225194178
Name:WATTERS, JULIEANNE RENEE (DO)
Entity Type:Individual
Prefix:
First Name:JULIEANNE
Middle Name:RENEE
Last Name:WATTERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:RENEE
Other - Last Name:COFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 WILSON AVE
Mailing Address - Street 2:WASHINGTON HOSPITAL
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3336
Mailing Address - Country:US
Mailing Address - Phone:724-223-3342
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:155 WILSON AVE
Practice Address - Street 2:WASHINGTON HOSPITAL
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3336
Practice Address - Country:US
Practice Address - Phone:724-223-3342
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013781207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine