Healthcare Provider Details

I. General information

NPI: 1336181270
Provider Name (Legal Business Name): ROBERT S WARREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST SUITE B-102
DANVERS MA
01923-2763
US

IV. Provider business mailing address

75 SYLVAN ST SUITE B-102
DANVERS MA
01923-2763
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-7566
  • Fax: 781-373-6690
Mailing address:
  • Phone: 978-774-7566
  • Fax: 781-373-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number161223
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number161223
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number161223
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: