MEDICARE: DR. WILLIAM ADDISON WARREN M.D.

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	D13916	MD
2	207RP1001X	Pulmonary Disease Physician	D13916	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80160003	OTHER	DC	BLUE SHIELD NATIONAL AREA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	36778001	OTHER	MD	BLUE SHIELD OF MD

General Provider Information

NPI Number	:	1669478285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ADDISON WARREN M.D.

Provider Business Mailing Address
First Line	:	8871 GORMAN ROAD
Second Line	:	STE 300
City	:	LAUREL
State	:	MD
Zip	:	20723
Country	:	US
Telephone Number	:	301-498-3150
Fax Number	:	301-490-2411

Provider Business Practice Location Address
First Line	:	8871 GORMAN ROAD
Second Line	:	STE 300
City	:	LAUREL
State	:	MD
Zip	:	20723
Country	:	US
Telephone Number	:	301-498-3150
Fax Number	:	301-490-2411

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	06/06/2016

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