Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC011560 | PA |
NPI | 1730840257 |
---|---|
Provider Name | Dr. Robert Scott Waterson |
First Address | West Chester, PA 19382-2865 |
Second Address | Chadds Ford, PA 19317-9672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2022 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1770651861 | (05) | PA |