Provider Demographics
NPI:1558343152
Name:WATKINS, BRIAN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 LINDEN OAKS
Mailing Address - Street 2:SUITE #300
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2814
Mailing Address - Country:US
Mailing Address - Phone:585-383-8830
Mailing Address - Fax:585-383-8918
Practice Address - Street 1:1200 DRIVING PARK AVE STE 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1090
Practice Address - Country:US
Practice Address - Phone:315-359-2670
Practice Address - Fax:315-359-2675
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42614208600000X
NY239602208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I16216Medicare UPIN