Healthcare Provider Details

I. General information

NPI: 1972508653
Provider Name (Legal Business Name): CALVIN G. WARREN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 NEWMAN ROAD
NEW BERN NC
28562
US

IV. Provider business mailing address

703 NEWMAN ROAD
NEW BERN NC
28562
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-2900
  • Fax: 252-633-9609
Mailing address:
  • Phone: 252-633-2900
  • Fax: 252-633-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31756
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8985759
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: