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Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTIAN WATHEN M.D. (OWNER)
(302) 832-5099
Entity
Organization

Contact information

Practice address
2443 MCCOY RD, BEAR, DE 19701-1931
(302) 832-5099
Mailing address
2443 MCCOY RD, BEAR, DE 19701-1931
(302) 832-5099

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C1-0006473
DE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1000034715
DE
Enumeration date
07/08/2006
Last updated
08/22/2020
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