Provider Demographics
NPI:1780079467
Name:WATSON, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 DELAWARE AVENUE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225
Mailing Address - Country:US
Mailing Address - Phone:716-868-4119
Mailing Address - Fax:
Practice Address - Street 1:69 DELAWARE AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3812
Practice Address - Country:US
Practice Address - Phone:716-852-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY498182-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker