Provider Demographics
NPI:1972597045
Name:WARREN, JAMES W (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:WARREN
Suffix:
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 1:4520 UNION DEPOSIT ROAD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111
Mailing Address - Country:US
Mailing Address - Phone:717-652-6105
Mailing Address - Fax:717-652-2165
Practice Address - Street 1:4518 UNION DEPOSIT RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111
Practice Address - Country:US
Practice Address - Phone:717-652-5840
Practice Address - Fax:717-652-8152
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026416E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009072610020Medicaid
PA0009072310021Medicaid
PA0009072610015Medicaid
PA0009072610017Medicaid
PA0009072610001Medicaid
PA300057789OtherRAILROAD MEDICARE
PA300057789OtherRAILROAD MEDICARE
PA0009072610015Medicaid
PAC33763Medicare UPIN
PA0009072610017Medicaid
PA0009072310021Medicaid
PA418825H96Medicare PIN
PA418825NSUMedicare PIN