Provider Demographics
NPI:1255497095
Name:JONATHAN WARREN MD PC
Entity Type:Organization
Organization Name:JONATHAN WARREN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-253-2256
Mailing Address - Street 1:77 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3636
Mailing Address - Country:US
Mailing Address - Phone:610-253-2256
Mailing Address - Fax:610-253-6547
Practice Address - Street 1:77 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3636
Practice Address - Country:US
Practice Address - Phone:610-253-2256
Practice Address - Fax:610-253-6547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012069E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9905019OtherHORIZON BC BS
PA02568600OtherCAPITAL BLUE CROSS
PA120107OtherHIGHMARK BLUE SHIELD
NJ3542602Medicaid
PA0006143590002Medicaid
PA120107OtherHIGHMARK BLUE SHIELD
PA9905019OtherHORIZON BC BS