Provider Demographics
NPI:1760747174
Name:WATSON, DOROTHY (CNA, CMT, TME, DSP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNA, CMT, TME, DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 SHEPPERTON TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6715
Mailing Address - Country:US
Mailing Address - Phone:301-825-6251
Mailing Address - Fax:
Practice Address - Street 1:2921 SHEPPERTON TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6715
Practice Address - Country:US
Practice Address - Phone:301-825-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1760747174OtherMEDICARE