Provider Demographics
NPI:1083633093
Name:WARREN, PEGGY ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:ELLEN
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - Street 2:PO BOX 9142
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:40 WINDSOR ROAD
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468
Practice Address - Country:US
Practice Address - Phone:617-964-3506
Practice Address - Fax:617-964-9598
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA545642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry