Provider Demographics
NPI:1730365040
Name:WATSON, ERIN E (OTRL)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:E
Last Name:WATSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MILL ST
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532
Mailing Address - Country:US
Mailing Address - Phone:301-689-5736
Mailing Address - Fax:
Practice Address - Street 1:ONE BAKER PLACE
Practice Address - Street 2:MINERAL CO BOARD OF EDUCATION
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726
Practice Address - Country:US
Practice Address - Phone:304-788-4200
Practice Address - Fax:304-788-6461
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13532083X0100X
MD047382083X0100X
PA0L0083252083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010521Medicaid