Provider Demographics
NPI:1689618225
Name:WATSON, DANIEL LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 36488
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6488
Mailing Address - Country:US
Mailing Address - Phone:704-248-3400
Mailing Address - Fax:704-337-8387
Practice Address - Street 1:325 HAWTHORNE LN STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2433
Practice Address - Country:US
Practice Address - Phone:704-372-5180
Practice Address - Fax:704-337-8387
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9600768208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC85978OtherBCBS NC INDI PROVIDER #
NC2226491DOtherNORTH CAROLINA MEDICARE #
NC24235OtherPARTNERS MCRE PROV#
NC340016943OtherRAILROAD MCRE PROV#
NC24235OtherPARTNERS MCRE PROV#
NC85978OtherBCBS NC INDI PROVIDER #
NCG29337Medicare UPIN