Provider Demographics
NPI:1366641508
Name:RICHARD R. WATKINS, M.D.., LLC
Entity Type:Organization
Organization Name:RICHARD R. WATKINS, M.D.., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-344-6643
Mailing Address - Street 1:224 W EXCHANGE ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-6643
Mailing Address - Fax:330-762-7196
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:SUITE 290
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-6643
Practice Address - Fax:330-762-7196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087510207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHI60702Medicare UPIN