Provider Demographics
NPI:1942205109
Name:WATSON, NOEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:J
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8996
Mailing Address - Fax:937-855-7279
Practice Address - Street 1:1217 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1715
Practice Address - Country:US
Practice Address - Phone:937-855-7275
Practice Address - Fax:937-855-7279
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-3754-W207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH421534506OtherCIGNA
OH1007306OtherAETNA
OH34001319OtherMECICAL LICENSE
OH421534506096OtherCARESOURCE
OH000000227850OtherBCBS-OH
OH35033754OtherMEDICAL LICENSE
OH080191720OtherRAILROAD MEDICARE
OH0181717Medicaid
OH000000227850OtherBCBS-OH
OH080191720OtherRAILROAD MEDICARE