Healthcare Provider Details

I. General information

NPI: 1275109712
Provider Name (Legal Business Name): CHRISTOPHER JOHN WARREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 PARK RD STE 130
CHARLOTTE NC
28210-8538
US

IV. Provider business mailing address

9735 KINCEY AVE STE 201
HUNTERSVILLE NC
28078-9120
US

V. Phone/Fax

Practice location:
  • Phone: 704-752-3730
  • Fax: 704-752-9056
Mailing address:
  • Phone: 704-414-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number66538
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: