MEDICARE: MEDICAL ASSOCIATES OF WARREN, INC.

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	207R00000X	Internal Medicine Physician	35068993	OH

General Provider Information

NPI Number	:	1649450032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ASSOCIATES OF WARREN, INC.

Provider Business Mailing Address
First Line	:	9375 E MARKET ST
Second Line	:	SUITE NUMBER 2
City	:	WARREN
State	:	OH
Zip	:	44484-5552
Country	:	US
Telephone Number	:	330-609-5277
Fax Number	:	330-609-5294

Provider Business Practice Location Address
First Line	:	9375 E MARKET ST
Second Line	:	SUITE NUMBER 2
City	:	WARREN
State	:	OH
Zip	:	44484-5552
Country	:	US
Telephone Number	:	330-609-5277
Fax Number	:	330-609-5294

Authorized Official
Title or Position	:	C.E.O
Name	:	DR. KAPIL KWATRA
Credential	:	M.D.
Telephone Number	:	330-609-5277

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	04/08/2013

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