Individual
TERRY WATKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12007 SUNRISE VALLEY DR, SUITE 120, RESTON, VA 20191-3479
(301) 624-5730
(301) 624-5731
Mailing address
PO BOX 79429, BALTIMORE, MD 21279-0429
(301) 624-5730
(301) 624-5731
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
010104747
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007110341
—
VA
01
—
0500138
UNITED HEALTHCARE
VA
01
—
130018728
RAILROAD MEDICARE
VA
01
—
244468
ANTHEM
VA
01
—
283590
AMERIGROUP
VA
01
—
4053661
AETNA
VA
01
—
4571 0003
CF BC BS DC
DC
01
—
505096
NCPPO
VA
01
—
535088 02
CF BC BS MD/NASCO
MD
01
—
85488
MAMSI/ALLIANCE
VA
Enumeration date
09/13/2006
Last updated
07/08/2007
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