Provider Demographics
NPI:1437338506
Name:GALEN R WARREN MD, INC
Entity Type:Organization
Organization Name:GALEN R WARREN MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, RMA, GMO
Authorized Official - Phone:513-871-1971
Mailing Address - Street 1:2752 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2207
Mailing Address - Country:US
Mailing Address - Phone:513-871-1971
Mailing Address - Fax:513-871-2082
Practice Address - Street 1:2752 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2207
Practice Address - Country:US
Practice Address - Phone:513-871-1971
Practice Address - Fax:513-871-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH030194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0195524Medicaid
OH0195524Medicaid