Provider Demographics
NPI:1386715639
Name:WARREN, THOMAS BRENT (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRENT
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:140 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7561
Mailing Address - Country:US
Mailing Address - Phone:704-664-9638
Mailing Address - Fax:704-664-1859
Practice Address - Street 1:140 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8522
Practice Address - Country:US
Practice Address - Phone:704-664-9638
Practice Address - Fax:704-664-1859
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000659207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130KYOtherBCBS
NC89130KYMedicaid
NC130KYOtherBCBS
NC89130KYMedicaid