Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Connor Andrew Wathen

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1619464989

Connor Andrew Wathen is a Neurosurgery in Philadelphia, Rhode Island. Qualified in 2018, 8 years ago. Practices with Lifespan Physician Group Inc, a 1,125-clinician group and accepts Medicare assignment. Licensed in Pennsylvania and Rhode Island.

Years since qualifying
8
Licensed in
PA, RI
In the registry since
2018
Specialties on file
2

Practice location Address checks out

593 Eddy Street Apc 6
Philadelphia, RI 02903-4923
Phone: (401) 793-9166
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neurological Surgery Physician (primary) Taxonomy 207T00000X · Licence MD20205 (RI)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (PA)

Record details

NPI number1619464989
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 22, 2018
Last updated in NPPESJune 6, 2025
Certification dateMay 21, 2025
Mailing address117 Ellenfield St Ste 101, Providence, RI 02905-4541

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNEUROSURGERY
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Lifespan Physician Group Inc — 1125 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount