Provider Demographics
NPI:1306826284
Name:WATT, NIGEL ALAN RODERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:NIGEL
Middle Name:ALAN RODERICK
Last Name:WATT
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7092
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:1005 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2707
Practice Address - Country:US
Practice Address - Phone:843-777-7900
Practice Address - Fax:843-777-7925
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16971207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLL1040Medicaid
SCLL1040Medicaid
SCE915671271Medicare ID - Type UnspecifiedMEDICARE