Provider Demographics
NPI:1790890168
Name:WATSON, SARAH WERNER (PA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:WERNER
Last Name:WATSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:W
Other - Last Name:STERBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1802
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-1802
Mailing Address - Country:US
Mailing Address - Phone:860-567-1011
Mailing Address - Fax:860-350-2224
Practice Address - Street 1:9 EAST ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3601
Practice Address - Country:US
Practice Address - Phone:860-567-1011
Practice Address - Fax:860-350-2224
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001445207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
S 74548Medicare UPIN
970001506Medicare ID - Type Unspecified