Healthcare Provider Details

I. General information

NPI: 1215187976
Provider Name (Legal Business Name): KATHERYN M WARREN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 OMEGA DR E-62 OMEGA PROFESSIONAL CENTER
NEWARK DE
19713
US

IV. Provider business mailing address

E-62 OMEGA DR OMEGA PROFESSIONAL CENTER
NEWARK DE
19713-2061
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-9611
  • Fax: 302-368-3424
Mailing address:
  • Phone: 302-368-9611
  • Fax: 302-368-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC10004472
License Number StateDE

VIII. Authorized Official

Name: AILEEN LENNON
Title or Position: BILLING MANAGER
Credential:
Phone: 302-368-9611