Provider Demographics
NPI:1083696173
Name:WARREN, CALVIN E JR (MD MSMM CPE)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:E
Last Name:WARREN
Suffix:JR
Gender:M
Credentials:MD MSMM CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4257
Mailing Address - Country:US
Mailing Address - Phone:216-229-2599
Mailing Address - Fax:
Practice Address - Street 1:7400 W CAMPUS RD
Practice Address - Street 2:AETNA F489
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8725
Practice Address - Country:US
Practice Address - Phone:614-933-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine