1730365040 NPI number — MRS. ERIN E WATSON OTRL

Table of content: MRS. ERIN E WATSON OTRL (NPI 1730365040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730365040 NPI number — MRS. ERIN E WATSON OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON
Provider First Name:
ERIN
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730365040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 MILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FROSTBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-689-5736
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE BAKER PLACE
Provider Second Line Business Practice Location Address:
MINERAL CO BOARD OF EDUCATION
Provider Business Practice Location Address City Name:
KEYSER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-788-4200
Provider Business Practice Location Address Fax Number:
304-788-6461
Provider Enumeration Date:
01/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  1353 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2083X0100X , with the licence number: 04738 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083X0100X , with the licence number: 0L008325 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810010521 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".