Individual
DR. THOMAS K. WATANABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
60 TOWNSHIP LINE RD, ELKINS PARK, PA 19027-2220
(215) 663-6677
(215) 663-6265
Mailing address
5501 OLD YORK RD, KORMAN 202, PHILADELPHIA, PA 19141-3018
(215) 254-2695
(215) 456-5926
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
35-065929
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000012518
ANTHEM
—
05
—
0133117
—
OH
05
—
200241860
—
IN
05
—
64957608
—
KY
Enumeration date
06/30/2006
Last updated
12/08/2014
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