Provider Demographics
NPI:1093764482
Name:MCCARTER, WARREN (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:MCCARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4386 WORSHAM RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-6937
Mailing Address - Country:US
Mailing Address - Phone:804-598-3715
Mailing Address - Fax:
Practice Address - Street 1:800 OAK ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1199
Practice Address - Country:US
Practice Address - Phone:434-392-8811
Practice Address - Fax:800-536-8431
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035503207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010146046Medicaid
P00207725OtherRAILROAD MCR
VA010146046Medicaid
VAVAA113460Medicare PIN
VA007178E48Medicare PIN