Provider Demographics
NPI:1497373492
Name:WATKINS, IRENE MARIE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:MARIE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N WASHINGTON ST APT 237
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1760
Mailing Address - Country:US
Mailing Address - Phone:301-613-5976
Mailing Address - Fax:
Practice Address - Street 1:6250 COLUMBIA CROSSING CIR # 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-8010
Practice Address - Country:US
Practice Address - Phone:240-706-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD620871744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty