Provider Demographics
NPI:1841233442
Name:WATT, COURTENAY CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTENAY
Middle Name:CRAIG
Last Name:WATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:305 CAYUGA RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1980
Mailing Address - Country:US
Mailing Address - Phone:716-681-8838
Mailing Address - Fax:716-564-1134
Practice Address - Street 1:1540 MAPLE RD
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3647
Practice Address - Country:US
Practice Address - Phone:716-681-8838
Practice Address - Fax:716-564-1134
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2026711207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01647685Medicaid
NY00046086801OtherUNIVERA HEALTH CARE
NY000524706003OtherBLUE CROSS BLUE SHIELD
NY040426000857OtherFIDELIS
NY3910437OtherINDEPENDENT HEALTH
NY930039380OtherRAILROAD MEDICARE
NY00046086801OtherUNIVERA HEALTH CARE
NY01647685Medicaid