Provider Demographics
NPI:1871572602
Name:WATSON, CAROLYN S (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name: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:PO BOX 8317
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8317
Mailing Address - Country:US
Mailing Address - Phone:270-575-2244
Mailing Address - Fax:270-415-7130
Practice Address - Street 1:2501 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3813
Practice Address - Country:US
Practice Address - Phone:270-575-2244
Practice Address - Fax:270-415-7130
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25920207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY220014165OtherMEDICARE RAILROAD
KY64259203Medicaid
KY0271205Medicare PIN
KY64259203Medicaid