Provider Demographics
NPI:1578654976
Name:WATSON LEONE, CAROL LOUISE (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:WATSON LEONE
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 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:608-224-6205
Mailing Address - Fax:860-826-4957
Practice Address - Street 1:300 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3916
Practice Address - Country:US
Practice Address - Phone:860-224-6205
Practice Address - Fax:860-826-4957
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42373207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001423730Medicaid
CT001423730Medicaid