Provider Demographics
NPI:1417925215
Name:WARNER, ROBERT C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:WARNER
Suffix:JR
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 1:242 E STATE ST EXT
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-6039
Mailing Address - Country:US
Mailing Address - Phone:518-725-2227
Mailing Address - Fax:518-725-2252
Practice Address - Street 1:242 E STATE ST EXT
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-6039
Practice Address - Country:US
Practice Address - Phone:518-725-2227
Practice Address - Fax:518-725-2252
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00965480Medicaid
NY10002138OtherCDPHP HEALTHPLAN
NY0000401408002OtherBLUE SHIELD NENY
NY11160OtherMOHAWK VALLEY PHYSICIANS
NY00965480Medicaid
NY11160OtherMOHAWK VALLEY PHYSICIANS