Healthcare Provider Details

I. General information

NPI: 1700856416
Provider Name (Legal Business Name): WARREN HSU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 GARDNER DR
WILMINGTON NC
28405-8873
US

IV. Provider business mailing address

1705 GARDNER DR
WILMINGTON NC
28405-8873
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-5300
  • Fax:
Mailing address:
  • Phone: 910-343-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number008269
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2009-00063
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: