Provider Demographics
NPI:1487743928
Name:WATSON, MICHELLE N (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:N
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1800
Mailing Address - Country:US
Mailing Address - Phone:860-464-7248
Mailing Address - Fax:860-464-0125
Practice Address - Street 1:1527 ROUTE 12
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1800
Practice Address - Country:US
Practice Address - Phone:860-464-7248
Practice Address - Fax:860-464-0125
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1241233OtherUNITED HEALTH CARE
OV9498OtherHEALTH NET
061223645OtherCIGNA
CT001388299Medicaid
P2364696OtherOXFORD
010038829CT01OtherBLUE CROSS
038829OtherCONNECTICARE
01225RMedicare UPIN