Individual
DR. GEORGE H WATHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PA
Contact information
Practice address
11345 PEMBROOKE SQ, SUITE 103, WALDORF, MD 20603-4804
(301) 645-8144
(301) 870-8392
Mailing address
11345 PEMBROOKE SQ, STE 103, WALDORF, MD 20603-4804
(301) 645-8144
(301) 870-8392
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0020629
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110128523
RR MEDICARE
—
05
—
326971000
—
MD
Enumeration date
03/28/2006
Last updated
02/15/2008
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