Provider Demographics
NPI:1568423556
Name:SCOTT WATKINS MD PC
Entity Type:Organization
Organization Name:SCOTT WATKINS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-964-1480
Mailing Address - Street 1:12500 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6393
Mailing Address - Country:US
Mailing Address - Phone:240-964-1480
Mailing Address - Fax:240-964-1490
Practice Address - Street 1:12500 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6393
Practice Address - Country:US
Practice Address - Phone:240-964-1480
Practice Address - Fax:240-964-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00622242085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016490810001Medicaid
WV0122100000Medicaid
MD941810501Medicaid
P00274052OtherRR MEDICARE
002376161OtherMARLYLAND PHYSICIANS CARE
MDK906OtherCAREFIRST
MDK906OtherCAREFIRST
P00274052OtherRR MEDICARE
MD246NMedicare PIN