Healthcare Provider Details

I. General information

NPI: 1578565297
Provider Name (Legal Business Name): RICHARD S WARNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 LOWER ST
SHELBURNE FALLS MA
01370-9402
US

IV. Provider business mailing address

191 LOWER ST
SHELBURNE FALLS MA
01370-9402
US

V. Phone/Fax

Practice location:
  • Phone: 413-625-9300
  • Fax: 413-625-6007
Mailing address:
  • Phone: 413-625-9300
  • Fax: 413-625-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44681
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: