Provider Demographics
NPI:1356326441
Name:WARNER, JON J P (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:J P
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-7300
Mailing Address - Fax:617-724-3846
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:YAWKEY 3G
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-7300
Practice Address - Fax:617-724-3846
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2014-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA54152207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA709388OtherTUFTS HEALTH PLAN
MA3025489Medicaid
MAJ06646OtherBCBS MA
MAA23373Medicare PIN
MA3025489Medicaid