Provider Demographics
NPI:1396868139
Name:WATSON, SUSANNAH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:
Last Name:WATSON
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 1:15 LARUE CT
Mailing Address - Street 2:
Mailing Address - City:BILTMORE LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8969
Mailing Address - Country:US
Mailing Address - Phone:617-901-7667
Mailing Address - Fax:
Practice Address - Street 1:15 LARUE CT
Practice Address - Street 2:
Practice Address - City:BILTMORE LAKE
Practice Address - State:NC
Practice Address - Zip Code:28715-8969
Practice Address - Country:US
Practice Address - Phone:617-901-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60003030207R00000X
VA0101250029207R00000X
NC2012-02156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine