Provider Demographics
NPI:1437440435
Name:WATSON, JESSICA SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUSAN
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 LOWELL STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2726
Mailing Address - Country:US
Mailing Address - Phone:207-774-8277
Mailing Address - Fax:207-699-5850
Practice Address - Street 1:885 UNION ST STE 130
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3088
Practice Address - Country:US
Practice Address - Phone:207-973-4185
Practice Address - Fax:207-973-4187
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-42456207W00000X
MEMD21388207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist