Provider Demographics
NPI:1386626133
Name:WARMAN, MARC JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:JAY
Last Name:WARMAN
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 1:409 MOUNTAIN LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-2424
Mailing Address - Country:US
Mailing Address - Phone:203-216-0178
Mailing Address - Fax:
Practice Address - Street 1:409 MOUNTAIN LAUREL RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-2424
Practice Address - Country:US
Practice Address - Phone:203-216-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033770208100000X
NY187314-1208100000X
MA213357208100000X
SC26576208100000X
PAMD419191208100000X
VA0101236022208100000X
NH12442208100000X
CODR42856208100000X
AZ33455208100000X
WAMD00044417208100000X
RIMD11636208100000X
KS04-31160208100000X
AL00026545208100000X
MDD0061188D208100000X
NC208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF80073Medicare UPIN
MD250000308Medicare ID - Type Unspecified