Tabitha a Watts MD LTD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036-108494 Issued in IL

Legal business name

TABITHA A WATTS MD LTD

Practice address

6545 Cermak Rd
Berwyn, IL 60402-2313

Phone

(708) 788-0077

Fax

(708) 788-5620

NPI assigned

Oct 22, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tabitha A Watts, MD

Title

President

Phone

(708) 788-0077

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256169600000",
    "number": "1750617908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6545 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022313",
            "telephone_number": "708-788-0077",
            "fax_number": "708-788-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022313",
            "telephone_number": "708-788-0077",
            "fax_number": "708-788-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABITHA A WATTS MD LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-22",
        "last_updated": "2009-10-22",
        "status": "A",
        "authorized_official_last_name": "WATTS",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-788-0077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-108494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036108494",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Berwyn, IL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.