Provider Demographics
NPI:1821274754
Name:WATLINGTON, JERRY JERMAINE
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:JERMAINE
Last Name:WATLINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1020
Mailing Address - Country:US
Mailing Address - Phone:610-789-3122
Mailing Address - Fax:
Practice Address - Street 1:201 E TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1020
Practice Address - Country:US
Practice Address - Phone:610-789-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy