Provider Demographics
NPI:1073926937
Name:WARREN, DAVID HUDSON
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HUDSON
Last Name:WARREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OVER STREAM LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6755
Mailing Address - Country:US
Mailing Address - Phone:704-289-3334
Mailing Address - Fax:704-844-8156
Practice Address - Street 1:251 N. TRADE STREET
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6755
Practice Address - Country:US
Practice Address - Phone:704-289-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704597Medicaid
NC5836360001Medicare NSC
NC1093888018Medicare UPIN