Individual
DR. PATRICK TIMOTHY WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O., F.A.A.F.P
Contact information
Practice address
2101 W LEHIGH AVE STE A, PHILADELPHIA, PA 19132-2664
(267) 866-7211
Mailing address
1395 NW 167TH ST, MIAMI GARDENS, FL 33169-5710
(267) 866-7211
(267) 202-7398
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
0S003179L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0058143000
KEYSTONE AND BLUE INDIV #
PA
01
—
85987
AETNA HMO ONLY
PA
Enumeration date
03/28/2006
Last updated
03/17/2020
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