Provider Demographics
NPI:1326230558
Name:WATKINS, RUNA DIWADKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUNA
Middle Name:DIWADKAR
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUNA
Other - Middle Name:
Other - Last Name:DIWADKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-5181
Mailing Address - Fax:410-706-5103
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:SUITE N5W70
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-0812
Practice Address - Fax:410-328-7305
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001934208000000X
MDD74504208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD365415000Medicaid