Provider Demographics
NPI:1366402844
Name:WARREN, CAROLYN SUE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:SUE
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1408 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1915
Mailing Address - Country:US
Mailing Address - Phone:304-345-3487
Mailing Address - Fax:304-345-9817
Practice Address - Street 1:1001 KENNAWA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1824
Practice Address - Country:US
Practice Address - Phone:304-925-2200
Practice Address - Fax:304-926-2238
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV10259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2002231-000Medicaid
WVWA0840082Medicare ID - Type Unspecified
WV2002231-000Medicaid