Provider Demographics
NPI:1891315693
Name:WATSON, RONALD EUGENE
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EUGENE
Last Name:WATSON
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 1:6501 OGLETHORPE MILL DR
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5689
Mailing Address - Country:US
Mailing Address - Phone:202-321-9957
Mailing Address - Fax:866-402-4578
Practice Address - Street 1:1415 RHODE ISLAND AVE NW APT 906
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-5412
Practice Address - Country:US
Practice Address - Phone:202-588-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant