Basic Information
| Provider Information | |||||||||
| NPI: | 1841233442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATT | ||||||||
| FirstName: | COURTENAY | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 CAYUGA RD | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142251980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166818838 | ||||||||
| FaxNumber: | 7165641134 | ||||||||
| Practice Location | |||||||||
| Address1: | 1540 MAPLE RD | ||||||||
| Address2: | EMERGENCY ROOM | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142213647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166818838 | ||||||||
| FaxNumber: | 7165641134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 10/02/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2026711 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01647685 | 05 | NY | MEDICAID | 00046086801 | 01 | NY | UNIVERA HEALTH CARE | OTHER | 000524706003 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 040426000857 | 01 | NY | FIDELIS | OTHER | 3910437 | 01 | NY | INDEPENDENT HEALTH | OTHER | 930039380 | 01 | NY | RAILROAD MEDICARE | OTHER |