Provider Demographics
NPI:1275976250
Name:WATTERS, NATHAN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:PAUL
Last Name:WATTERS
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 1:150 CENTURY PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT.LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1129
Mailing Address - Country:US
Mailing Address - Phone:856-778-4700
Mailing Address - Fax:856-778-1154
Practice Address - Street 1:150 CENTURY PKWY STE A
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1129
Practice Address - Country:US
Practice Address - Phone:856-778-4700
Practice Address - Fax:856-778-1154
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10122400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty