Healthcare Provider Details

I. General information

NPI: 1669478285
Provider Name (Legal Business Name): WILLIAM ADDISON WARREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8871 GORMAN ROAD STE 300
LAUREL MD
20723
US

IV. Provider business mailing address

8871 GORMAN ROAD STE 300
LAUREL MD
20723
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-3150
  • Fax: 301-490-2411
Mailing address:
  • Phone: 301-498-3150
  • Fax: 301-490-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD13916
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD13916
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: