Provider Demographics
NPI:1851602635
Name:WATSON, MARTHA AMANDA (PHD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:AMANDA
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FIELDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-5804
Mailing Address - Country:US
Mailing Address - Phone:814-866-2428
Mailing Address - Fax:
Practice Address - Street 1:210 FIELDSTONE WAY
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-5804
Practice Address - Country:US
Practice Address - Phone:814-866-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator