Provider Demographics
NPI:1689661555
Name:WATSON, MICHAEL ROY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-639-3915
Mailing Address - Fax:717-639-3960
Practice Address - Street 1:844 TUCK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7477
Practice Address - Country:US
Practice Address - Phone:717-639-3915
Practice Address - Fax:717-639-3960
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043820E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA237440OtherUNISON-WMG
PA50074899OtherCAPITAL BLUE CROSS-WMG
PA7534091OtherAETNA
PA1520834OtherGATEWAY-WMG
PA786823OtherHIGHMARK BLUE SHIELD
PA211162OtherJOHNS HOPKINS
MD919374OtherCAREFIRST MD BCBS
PA00154415Medicaid
PA20069233OtherAMERIHEALTH MERCY-WMG
PA786823Medicare PIN
PA00154415Medicaid