Provider Demographics
NPI:1194036145
Name:GRACE, WARREN LEE III (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:LEE
Last Name:GRACE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2500 MORRIS AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5675
Mailing Address - Country:US
Mailing Address - Phone:732-960-9600
Mailing Address - Fax:932-906-9300
Practice Address - Street 1:2500 MORRIS AVE STE 220
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5675
Practice Address - Country:US
Practice Address - Phone:732-960-9600
Practice Address - Fax:932-906-9300
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10911200208VP0014X
NJNJDCATEMP-021052208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP01590940OtherRR MEDICARE
WV0011253000OtherMEDICAID GROUP
WVCF9824OtherRR MEDICARE GROUP
WV3810029223Medicaid
WV9296571OtherMEDICARE GROUP
WV3810029223Medicaid