Individual
DEBORAH WATERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
210 S MAIN ST, SUITE A, MIDDLETOWN, CT 06457-3764
(860) 638-4671
(860) 638-4673
Mailing address
210 S MAIN ST, SUITE A, MIDDLETOWN, CT 06457-3764
(860) 638-4671
(860) 638-4673
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000735
CT
213ES0131X
Foot Surgery Podiatrist
000735
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C03117
MEDICARE ID
CT
Enumeration date
05/05/2006
Last updated
06/07/2012
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