MOUNTAIN MEDICAL OF WATERTOWN (NPI# 1306068812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306068812 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN MEDICAL OF WATERTOWN |
| Practice Address |
457 Gaffney Dr Watertown NY 13601 |
| Practice Telephone | 3157792273 |
| Practice Fax Number | 3157792274 |
| Mailing Telephone | 3157792273 |
| Mailing Fax Number | 3157792274 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. MARK A KNOWLES (PA) |
| Authorized Official Telephone | 3157792273 |
| Authorized Official Credential | PA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 001608-1 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
457 GAFFNEY DR |
| City | WATERTOWN |
| State | NY |
| Zip Code | 13601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639721137 | Selina M Villanueva | Nurse Practitioner | 457 Gaffney Dr, Watertown, NY 13601 | 2019-07-15 |
| 1194924134 | Watertown Urgent Care Pllc | Internal Medicine | 457 Gaffney Dr, Watertown, NY 13601-1834 | 2007-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801414156 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 122 Court Street, Empsall Bldg, Room 212, Watertown, NY 13601 | 2020-07-13 |
| 1083231377 | Katherine Anne Cahill | Counselor | 22679 Duffy Road, Watertown, NY 13601 | 2020-07-02 |
| 1851855431 | Hanna Kearney | Physical Therapist | 20053 Summit View Blvd Ste 2, Watertown, NY 13601 | 2019-01-28 |
| 1578039905 | North Country Counseling Services LLC | Counselor | 210 Court St. Suite 4, Watertown, NY 13601 | 2018-10-24 |
| 1073004388 | Megan Anna O'brien | Counselor | 221 S Rutland Street, Watertown, NY 13601 | 2018-05-22 |
| 1558860536 | Kimberly Lynne Amelio | Specialist | 24850 Hinds Rd, Watertown, NY 13601 | 2018-02-06 |
| 1952840050 | Alberto Gonzalez | Social Worker | 211 Jb Wise Plaza, Watertown, NY 13601 | 2017-02-22 |
| 1073967386 | Amanda Pisarski | Licensed Practical Nurse | 26713 Nys Rte 12, Watertown, NY 13601 | 2016-04-22 |
| 1396137709 | Daniel Ernest Morgan | Neuromusculoskeletal Medicine & OMM | 21101 Ny-12f, Building 2, Suite 7, Watertown, NY 13601 | 2015-02-21 |
| 1568868131 | Megan E. Zamora | Dental Hygienist | 14652-b Cedar Way, Watertown, NY 13601 | 2014-11-10 |
| Find all providers in zip 13601 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457961765 | Samantha Jewers | Physician Assistant | 20 California Park, Watertown, MA 02472-2517 | 2020-08-03 |
| 1134757743 | Hira Bakshi | Physician Assistant | 295 Barben Ave, Watertown, NY 13601-4501 | 2020-03-30 |
| 1538795661 | Stephen Robinson | Physician Assistant | 26076 Liberty Ave, Watertown, NY 13601-5910 | 2020-03-20 |
| 1730695941 | Razi Odean Mirshahi | Physician Assistant | 183 Mount Auburn St Apt 46, Watertown, MA 02472-4012 | 2017-12-26 |
| 1790111797 | Marisa Hamlin | Physician Assistant | 22670 Summit Dr Bldg 6, Watertown, NY 13601-7208 | 2013-09-23 |
| 1639476260 | Kell T Giffin | Physician Assistant | 930 Holcomb St, Watertown, NY 13601-4228 | 2011-02-17 |
| 1073677498 | Nonna Khachiyan | Physician Assistant | 11 Mason Rd, Watertown, MA 02472-3314 | 2006-12-20 |
| 1528167277 | Mark Andrew Knowles | Physician Assistant | 457 Gaffney Drive, Watertown, NY 13601-1834 | 2006-09-21 |
| 1336167709 | Michelle Lynne Boulton | Physician Assistant | 171 E. Hoard Street, Watertown, NY 13601-1515 | 2006-07-17 |
| 1437191277 | Steven D Tiernan | Physician Assistant | 22670 Summit Dr, Ste 3, Watertown, NY 13601-7208 | 2006-06-12 |
| Find all providers in WATERTOWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.