Individual
WILLIAM WATTERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2410 PAGEHURST DRIVE, MIDLOTHIAN, VA 23113
(804) 897-6140
(804) 897-6141
Mailing address
2410 PAGEHURST DR, MIDLOTHIAN, VA 23113-6411
(804) 897-6140
(804) 897-6141
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101052275
VA
207R00000X
Internal Medicine Physician
Primary
101052275
VA
208000000X
Pediatrics Physician
101052275
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006736319
—
VA
01
—
141554
BLUE SHIELD
VA
05
—
1578588976
—
VA
01
—
333920
BLUE SHIELD
VA
01
—
333922
BLUE SHIELD
VA
Enumeration date
07/13/2006
Last updated
07/14/2011
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