=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215187976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHERYN M WARREN MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2008
-----------------------------------------------------
Last Update Date | 04/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 62 OMEGA DR E-62 OMEGA PROFESSIONAL CENTER
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-368-9611
-----------------------------------------------------
Fax | 302-368-3424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | E-62 OMEGA DR OMEGA PROFESSIONAL CENTER
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19713-2061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-368-9611
-----------------------------------------------------
Fax | 302-368-3424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | AILEEN LENNON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-368-9611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | C10004472
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------