Provider Demographics
NPI:1194780379
Name:WARREN, HARRY LEE JR (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:LEE
Last Name:WARREN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NMC PORTSMOUTH
Mailing Address - Street 2:620 JOHN PAUL JONES CIRCLE
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708
Mailing Address - Country:US
Mailing Address - Phone:757-314-7595
Mailing Address - Fax:
Practice Address - Street 1:ORTHO CLINIC
Practice Address - Street 2:MC DONALD ARMY HEALTH CENTER
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604
Practice Address - Country:US
Practice Address - Phone:757-314-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3896207XX0005X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery