MEDICARE: DR. WILBERT ROY WARREN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD058046-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548228489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILBERT ROY WARREN M.D.

Provider Business Mailing Address
First Line	:	1740 SOUTH ST
Second Line	:	STE 300
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1514
Country	:	US
Telephone Number	:	215-732-0876
Fax Number	:	215-732-4162

Provider Business Practice Location Address
First Line	:	1740 SOUTH ST
Second Line	:	STE 300
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1514
Country	:	US
Telephone Number	:	215-732-0876
Fax Number	:	215-732-4162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	05/17/2021

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