Individual
JACK W MCWATTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11085 LITTLE PATUXENT PKWY, SUITE 101, COLUMBIA, MD 21044-2983
(410) 997-7979
(410) 997-9231
Mailing address
11085 LITTLE PATUXENT PKWY, SUITE 101, COLUMBIA, MD 21044-2983
(410) 997-7979
(410) 997-9231
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D27237
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005
CAREFIRST BCBS PPO,SPP,BC
MD
01
—
04071
AMERIGROUP
MD
01
—
0481422
AETNA HEALTHCARE HMO
MD
01
—
21750
JHHC
MD
01
—
225079
MAMSI CARDIOLOGY
MD
01
—
2500675
UNITED HEALTHCARE
MD
01
—
35016302
CAREFIRST BCBS MD
MD
05
—
403161000
—
MD
01
—
4105495
AETNA HEALTHCARE NON-HMO
MD
Enumeration date
03/07/2006
Last updated
01/22/2009
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