Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101-053004 | VA |
N | 208600000X | Surgeon | 0101-053004 | VA |
N | 208200000X | Surgeon | 0101053004 | VA |
N | 208600000X | Surgeon | 0101053004 | VA |
N | 208200000X | Surgeon | 01068504A | IN |
N | 208600000X | Surgeon | 01068504A | IN |
Y | 2086S0120X | Pediatric Surgery | 01068504A | IN |
NPI | 1598737843 |
---|---|
Provider Name | Terri-Ann Wattsman |
First Address | Roanoke, VA 24013-2232 |
Second Address | Roanoke, VA 24018-0720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200993180 | (05) | IN |
7309929 | (05) | VA |
G60615 | (02) | VA |