Provider Demographics
NPI:1396633434
Name:WATCHORN, MYRON
Entity type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:WATCHORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1452
Mailing Address - Country:US
Mailing Address - Phone:440-308-9479
Mailing Address - Fax:
Practice Address - Street 1:668 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1452
Practice Address - Country:US
Practice Address - Phone:440-308-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker