Individual
DR. MICAH M WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
44 E JIMMIE LEEDS RD STE 101, GALLOWAY, NJ 08205-9599
(609) 677-9729
Mailing address
44 E JIMMIE LEEDS RD STE 101, GALLOWAY, NJ 08205-9599
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
25MA10015600
NJ
2085R0202X
Diagnostic Radiology Physician
MD443009
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
25MA10015600
NJ
2085R0204X
Vascular & Interventional Radiology Physician
MD443009
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0294187
—
NJ
01
—
171293
MEDICARE
NJ
01
—
771293
NJ MEDICARE
NJ
01
—
771300
NJ MEDICARE
NJ
01
—
771305
NJ MEDICARE
NJ
Enumeration date
05/15/2008
Last updated
12/04/2019
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