Provider Demographics
NPI:1013996214
Name:WATTAR, ABDUL R (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:R
Last Name:WATTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3669
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:7700 UNIVERSITY CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-867-3331
Practice Address - Fax:513-867-2667
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000331560OtherANTHEM
OH341221800122OtherCARESOURCE
P00136360OtherRAILROAD MEDICARE
OH2050971Medicaid
OHF65300OtherSUMMACARE
OHWA4126594Medicare ID - Type Unspecified
OHF84063Medicare UPIN