Provider Demographics
NPI:1154305472
Name:WATKINS, MICHAEL T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-0908
Mailing Address - Fax:617-726-2560
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 458
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-0908
Practice Address - Fax:617-726-2560
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA560292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA056029OtherTUFTS HEALTH PLAN
MA3028232Medicaid
MAJ06928OtherBCBS MA
MAJ06928Medicare PIN
MA3028232Medicaid