Provider Demographics
NPI:1700913738
Name:WATTS, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 3100N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:19 BAKER AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1359
Practice Address - Country:US
Practice Address - Phone:845-483-5305
Practice Address - Fax:845-483-5302
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-12-15
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Provider Licenses
StateLicense IDTaxonomies
CO42756207T00000X
NY286555207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08874361Medicaid
015560OtherKAISER-COMMERCIAL NUMBER
NY286555OtherNYS LICENSE
CO08874361Medicaid
COCO301923Medicare PIN
COG46075Medicare UPIN