Organization Active NPI

Carol L Watson MD LLC

  • Obstetrics & Gynecology Physician
  • Enfield, CT
National Provider Identifier
1891984274
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
042373 Issued in CT
Legal business name
CAROL L WATSON MD LLC
Practice address
140 Hazard Avenue
Suite 107
Enfield, CT 06082-4520
Phone
(860) 749-4416
Fax
(860) 749-4506
NPI assigned
Oct 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

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

Authorized official

Name
Ms. Deborah L. Bouchard
Title
Practice Manager
Phone
(860) 749-4416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X 042373 CT Primary

Addresses

Primary practice location

140 Hazard Avenue
Suite 107
Enfield, CT 06082-4520

Mailing address

140 Hazard Ave
Suite 107
Enfield, CT 06082-4520
Phone (860) 749-4416

Other identifiers 1

IdentifierTypeStateIssuer
00142370MedicaidCT

National Provider Directory

National Provider Directory

Locations

30 W Avon Rd
Ste A
Avon, CT 06001
Phone (860) 675-6595

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1891984274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 HAZARD AVE",
            "address_2": "SUITE 107",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824520",
            "telephone_number": "860-749-4416",
            "fax_number": "860-749-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 HAZARD AVENUE",
            "address_2": "SUITE 107",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824520",
            "telephone_number": "860-749-4416",
            "fax_number": "860-749-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROL L WATSON MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "BOUCHARD",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "860-749-4416",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CT",
            "license": "042373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00142370",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; 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.