John Watts Haresch, MD
Individual provider Active NPI Family Medicine Physician · Kitty Hawk, NC
NPI 1194733808 · NPPES record last updated Mar 30, 2016
Key facts
- NPI
- 1194733808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 200101152 (NC)
- Practice address
- 6365 N Croatan Hwy
Suite B
Kitty Hawk, NC 27949-3800 - Phone
- (252) 480-6631
- Fax
- (252) 480-6630
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220411000374 | DC | Practitioner - Geriatric Medicine |
8426065202 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200101152 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Care for Your Health, Inc | Family Medicine | Current |
Accepting new patients |
| Vinu Ganti M.D., P.C. | Current |
Accepting new patients |
Locations
12800 Middlebrook Rd
Ste 204
Germantown, MD 20874
Phone (301) 540-8146
11120 New Hampshire Ave
Ste 509
Silver Spring, MD 20904
Phone (240) 844-2552
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 200101152 | NC | Yes |
Addresses
Primary practice location
6365 N Croatan Hwy
Suite B
Kitty Hawk, NC 27949-3800
Mailing address
2401 E St NW
Washington, DC 20225
Phone (202) 663-1718
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5906425 | Medicaid | NC |
Other names
- Dr. John William Watts
Other providers in Kitty Hawk, NC
- Alyssa Gottschalk
- Laurie Graham
- Robert Carl Gunther
- Hall Speech & Language Therapy, PLLC
- Sara E Hanks
- Henry Heermann
- Markus P. Heyder
- Hightide Healthcare PLLC
- Wendy Holcomb
- Daniel J. Hurley Jr.
All providers in Kitty Hawk, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.