Organization
C C NEUROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROCHE WATSON CRNP (PRACTICE OWNER)
(301) 870-7287
Entity
Organization
Contact information
Practice address
11637 TERRACE DR STE 100, WALDORF, MD 20602-3707
(301) 870-7287
Mailing address
11637 TERRACE DR STE 100, WALDORF, MD 20602-3707
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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