Provider Demographics
NPI:1144362427
Name:WATSON, KEVIN W (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:WATSON
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 1:911 W HENDERSON ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2736
Mailing Address - Country:US
Mailing Address - Phone:704-637-2750
Mailing Address - Fax:704-637-5514
Practice Address - Street 1:911 W HENDERSON ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2736
Practice Address - Country:US
Practice Address - Phone:704-637-2750
Practice Address - Fax:704-637-5514
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-01326208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128NJMedicaid
SCN01328Medicaid
NC89128NJMedicaid
SCN01328Medicaid