Provider Demographics
NPI:1689949653
Name:CAROL L. WATSON, MD, LLC
Entity Type:Organization
Organization Name:CAROL L. WATSON, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-356-4000
Mailing Address - Street 1:601 CHAPEL AVE E
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1454
Mailing Address - Country:US
Mailing Address - Phone:856-356-4000
Mailing Address - Fax:856-414-1660
Practice Address - Street 1:30 W AVON RD
Practice Address - Street 2:SUITE D
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3678
Practice Address - Country:US
Practice Address - Phone:860-404-2137
Practice Address - Fax:860-404-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty