Provider Demographics
NPI:1598016164
Name:HARRY W. WATERS, JR., MD
Entity Type:Organization
Organization Name:HARRY W. WATERS, JR., MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:412-279-2476
Mailing Address - Street 1:202 MEADOWGROVE CIR
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-5008
Mailing Address - Country:US
Mailing Address - Phone:412-279-2476
Mailing Address - Fax:412-276-5867
Practice Address - Street 1:202 MEADOWGROVE CIR
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-5008
Practice Address - Country:US
Practice Address - Phone:412-279-2476
Practice Address - Fax:412-276-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033290E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA300293OtherUPMC HEALTH PLAN
PA033216OtherHIGHMARK
PA033216OtherHIGHMARK
PAC28203Medicare UPIN