Provider Demographics
NPI:1326152414
Name:WATTS, LAURA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANNE
Last Name:WATTS
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 1:85 POHEGANUT DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3216
Mailing Address - Country:US
Mailing Address - Phone:860-448-6303
Mailing Address - Fax:860-448-9678
Practice Address - Street 1:85 POHEGANUT DR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3216
Practice Address - Country:US
Practice Address - Phone:860-448-6303
Practice Address - Fax:860-448-9678
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87919Medicare UPIN
080001791Medicare ID - Type Unspecified