Provider Demographics
NPI:1376188573
Name:WATSON, RAYMOND GEORGE
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:GEORGE
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 1:208 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3767
Mailing Address - Country:US
Mailing Address - Phone:978-632-0934
Mailing Address - Fax:888-607-9327
Practice Address - Street 1:287 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-8311
Practice Address - Country:US
Practice Address - Phone:978-632-0934
Practice Address - Fax:888-607-9327
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist