Provider Demographics
NPI:1922032531
Name:WATTS, MEREDITH ROE-RANZENBACH (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:ROE-RANZENBACH
Last Name:WATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEREDITH
Other - Middle Name:ROE
Other - Last Name:RANZENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4459862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102740006Medicaid
WA8209934Medicaid
WAG43347Medicare UPIN
WAP00165748Medicare PIN
PA102740006Medicaid
WA8802265Medicare PIN