MEDICARE: DR. MARSHALL CLAUDE WAREHAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	35-05-0634-W	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	180011133	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	311026469027	OTHER	OH	CARESOURCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	22364	OTHER	OH	COLE VISION
5	000000189353	OTHER	OH	ANTHEM BC/BS

General Provider Information

NPI Number	:	1114925112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL CLAUDE WAREHAM MD

Provider Business Mailing Address
First Line	:	5250 FAR HILLS AVE
Second Line	:	SUITE 207
City	:	DAYTON
State	:	OH
Zip	:	45429-2382
Country	:	US
Telephone Number	:	937-433-2300
Fax Number	:	937-433-0210

Provider Business Practice Location Address
First Line	:	5250 FAR HILLS AVE
Second Line	:	SUITE 207
City	:	DAYTON
State	:	OH
Zip	:	45429-2382
Country	:	US
Telephone Number	:	937-433-2300
Fax Number	:	937-433-0210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	03/12/2012

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Directions to “ DR. MARSHALL CLAUDE WAREHAM MD” Practice Location

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