Healthcare Provider Details

I. General information

NPI: 1740714781
Provider Name (Legal Business Name): GWENDOLYN WARREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WATER ST
BLUE HILL ME
04614-5231
US

IV. Provider business mailing address

65 WATER ST
BLUE HILL ME
04614-5231
US

V. Phone/Fax

Practice location:
  • Phone: 207-374-2311
  • Fax: 207-374-3981
Mailing address:
  • Phone: 207-374-2311
  • Fax: 207-374-3981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD28546
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: