Provider Demographics
NPI:1194036145
Name:GRACE, WARREN LEE III (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:LEE
Last Name:GRACE
Suffix:III
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:90 MATAWAN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2653
Mailing Address - Country:US
Mailing Address - Phone:732-441-7177
Mailing Address - Fax:732-441-7165
Practice Address - Street 1:10 PARSONAGE RD STE 208
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2429
Practice Address - Country:US
Practice Address - Phone:732-906-9600
Practice Address - Fax:732-377-0393
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10911200207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP01590940OtherRR MEDICARE
WV0011253000OtherMEDICAID GROUP
WVCF9824OtherRR MEDICARE GROUP
WV3810029223Medicaid
WV9296571OtherMEDICARE GROUP
WV3810029223Medicaid