Provider Demographics
NPI:1871550566
Name:WATSON, RICHARD M (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:WATSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:301 E CITY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1708
Mailing Address - Country:US
Mailing Address - Phone:610-617-1300
Mailing Address - Fax:610-617-0199
Practice Address - Street 1:301 E CITY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1708
Practice Address - Country:US
Practice Address - Phone:610-617-1300
Practice Address - Fax:610-617-0199
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS-007211-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1288524Medicaid
PAF26208Medicare UPIN
PA1288524Medicaid