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General NPI Number Information
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NPI Number | 1366402844
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Entity Type | Individual
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Provider Name | CAROLYN SUE WARREN MD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1001 KENNAWA DR
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City | CHARLESTON
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State | WV
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Zip | 25311-1824
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Country | US
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Telephone | 304-925-2200
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Fax | 304-926-2238
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Provider Business Mailing Address
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Address Line | 1408 BEDFORD RD
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City | CHARLESTON
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State | WV
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Zip | 25314-1915
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Country | US
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Telephone | 304-345-3487
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Fax | 304-345-9817
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 10259
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License Number State | WV
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