Healthcare Provider Details

I. General information

NPI: 1154309243
Provider Name (Legal Business Name): GREGORY P WARREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18697 BAGLEY RD
CLEVELAND OH
44130-3417
US

IV. Provider business mailing address

PO BOX 638269
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 440-816-6051
  • Fax:
Mailing address:
  • Phone: 440-816-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35-06-8930W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: