Provider Demographics
NPI:1285744771
Name:WATERS, GEORGE A (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:WATERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HAYWARD ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2113
Mailing Address - Country:US
Mailing Address - Phone:508-431-3600
Mailing Address - Fax:508-431-2545
Practice Address - Street 1:2 HAYWARD ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2113
Practice Address - Country:US
Practice Address - Phone:508-431-3600
Practice Address - Fax:508-431-2545
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151110207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA405121OtherTUFTS
MA110062181AMedicaid
MAB21165001OtherCIGNA
MA000000006883OtherBMC HEALTHNET
MA60849OtherFALLON
2502922OtherUHC
MA304018OtherHPHC
408490OtherRI BLUE CHIP
MAJ21871OtherMABC
408490OtherRI BLUE CHIP
MAA32279Medicare ID - Type Unspecified