Provider Demographics
NPI:1770930935
Name:WATSON, SHELLY HWANG (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:HWANG
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:HWANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE STREET
Practice Address - Street 2:MAUMENEE 215
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-5490
Practice Address - Fax:410-614-9172
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0089279207W00000X
MDP32567207W00000X
DC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program