Provider Demographics
NPI:1477567212
Name:EASTERLY, HARRY WATKEY III (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:WATKEY
Last Name:EASTERLY
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:94 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-4000
Mailing Address - Country:US
Mailing Address - Phone:528-764-6966
Mailing Address - Fax:508-764-2457
Practice Address - Street 1:94 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4000
Practice Address - Country:US
Practice Address - Phone:508-764-6966
Practice Address - Fax:508-764-2457
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-12-21
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Provider Licenses
StateLicense IDTaxonomies
MA33391208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA3313903Medicare PIN