Provider Demographics
NPI:1649298142
Name:WATSKY, KALMAN LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:KALMAN
Middle Name:LEWIS
Last Name:WATSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:330 ORCHARD ST
Mailing Address - Street 2:STE #103
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-789-4045
Mailing Address - Fax:203-789-3744
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:STE #103
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-4045
Practice Address - Fax:203-789-3744
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029613207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT070000392Medicare ID - Type Unspecified
CTE36200Medicare UPIN