Provider Demographics
NPI:1801865720
Name:WATTS, HELENA B (MD)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:B
Last Name:WATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 W SHERMAN AVENUE
Mailing Address - Street 2:BLDG 2 STE A
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361
Mailing Address - Country:US
Mailing Address - Phone:856-205-1770
Mailing Address - Fax:856-691-5984
Practice Address - Street 1:1051 W SHERMAN AVENUE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361
Practice Address - Country:US
Practice Address - Phone:856-205-1770
Practice Address - Fax:856-691-5984
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06187000207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6513808Medicaid
NJ6513808Medicaid
E87496Medicare UPIN