Provider Demographics
NPI:1861497695
Name:WATSON, CHARLES C (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:WATSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 MIAMISBURG CENTERVILLE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3858
Mailing Address - Country:US
Mailing Address - Phone:937-401-6822
Mailing Address - Fax:937-401-6910
Practice Address - Street 1:1989 MIAMISBURG CENTERVILLE RD STE 204
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3858
Practice Address - Country:US
Practice Address - Phone:937-401-6822
Practice Address - Fax:937-401-6910
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3378-W207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0629930Medicaid
OH34003378OtherMEDICAL LICENSE
OH421534506038OtherCARESOURCE
OH421534506019OtherCHAMPUS/TRICARE
OH000000383922OtherBCBS OHIO
OH2924716OtherAETNA
OH34003378OtherMEDICAL LICENSE
OH2924716OtherAETNA
OH0629930Medicaid