Provider Demographics
NPI:1598737843
Name:WATTSMAN, TERRI-ANN (MD)
Entity Type:Individual
Prefix:
First Name:TERRI-ANN
Middle Name:
Last Name:WATTSMAN
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 1:102 HIGHLAND AVE SE STE 404
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2232
Mailing Address - Country:US
Mailing Address - Phone:540-985-9812
Mailing Address - Fax:540-985-5328
Practice Address - Street 1:4348 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0720
Practice Address - Country:US
Practice Address - Phone:540-769-0976
Practice Address - Fax:540-857-5383
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-053004208600000X
IN01068504A208600000X, 2086S0120X
VA0101053004208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7309929Medicaid
IN200993180Medicaid
IN200993180Medicaid
INM400074430Medicare PIN
VAG60615Medicare UPIN
VA020042418Medicare PIN
VA020001355Medicare PIN