Organization
GEORGE H WATHEN MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE H WATHEN MD PA (PRESIDENT)
(301) 645-8144
Entity
Organization
Contact information
Practice address
SUITE 103, 11345 PEMBROOKE SQ, WALDORF, MD 20603-4804
(301) 645-8144
(301) 870-8392
Mailing address
11345 PEMBROOKE SQ, SUITE 103, WALDORF, MD 20603-4804
(301) 645-8144
(301) 870-8392
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D0020629
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG5923
R R MEDICARE
—
Enumeration date
11/16/2007
Last updated
02/15/2008
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