Provider Demographics
NPI:1215013024
Name:WARREN, THOMAS BAKER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BAKER
Last Name:WARREN
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 1:299 WADES WAY
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:SC
Mailing Address - Zip Code:29810-3203
Mailing Address - Country:US
Mailing Address - Phone:803-584-3216
Mailing Address - Fax:
Practice Address - Street 1:623 MEMORIAL AVE N
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:SC
Practice Address - Zip Code:29810-2715
Practice Address - Country:US
Practice Address - Phone:803-584-2128
Practice Address - Fax:803-584-2125
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD17742Medicare UPIN