Provider Demographics
NPI:1215187976
Name:KATHERYN M WARREN MD PA
Entity Type:Organization
Organization Name:KATHERYN M WARREN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-368-9611
Mailing Address - Street 1:E-62 OMEGA DR
Mailing Address - Street 2:OMEGA PROFESSIONAL CENTER
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2061
Mailing Address - Country:US
Mailing Address - Phone:302-368-9611
Mailing Address - Fax:302-368-3424
Practice Address - Street 1:62 OMEGA DR
Practice Address - Street 2:E-62 OMEGA PROFESSIONAL CENTER
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-368-9611
Practice Address - Fax:302-368-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004472174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty