Thomas G Watson, M.D.
Individual provider Active NPI Family Medicine Physician · Pine Grove, PA
NPI 1295701084 · NPPES record last updated Feb 2, 2011
Key facts
- NPI
- 1295701084
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD044873E (PA)
- Practice address
- 8 Oak Grove Rd
Suite 1
Pine Grove, PA 17963-1226 - Phone
- (570) 345-3321
- Fax
- (570) 345-6470
- NPI assigned
- Feb 23, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD044873E | PA | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD044873E | PA | Yes |
Addresses
Primary practice location
8 Oak Grove Rd
Suite 1
Pine Grove, PA 17963-1226
Mailing address
8 Oak Grove Rd.
Suite 1
Pottsville, PA 17901
Phone (570) 345-3321
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001304510 | Medicaid | PA |
Other providers in Pine Grove, PA
- Tri-Valley Pharmacy, Incorporated
- Cassandra Joy Ulinitz
- Anne J. Usuka
- Tanya Marie Wagner
- Anthony Walinsky
- Alethea Lenore Wessner
- West Schuylkill Physical Therapy Services, P.C.
- Patti S White
All providers in Pine Grove, PA · Family Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.