Provider Demographics
NPI:1881618320
Name:GIST-WATSON, PATRICIA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:GIST-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 1:144 WESTGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4209
Mailing Address - Country:US
Mailing Address - Phone:215-844-5437
Mailing Address - Fax:215-844-4721
Practice Address - Street 1:6643 CHEW AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2004
Practice Address - Country:US
Practice Address - Phone:215-844-5437
Practice Address - Fax:215-844-4722
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051296L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF73533Medicare UPIN