Provider Demographics
NPI:1225078181
Name:WARREN, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:WARREN
Suffix:
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 1:2421 EDGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2407
Mailing Address - Country:US
Mailing Address - Phone:216-932-2343
Mailing Address - Fax:440-257-3302
Practice Address - Street 1:23240 CHAGRIN BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5404
Practice Address - Country:US
Practice Address - Phone:216-765-0500
Practice Address - Fax:216-765-0521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350615992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0979419Medicaid
OH07373422Medicare ID - Type Unspecified
OH0979419Medicaid