Provider Demographics
NPI:1447220496
Name:WARREN, WAYNE S (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:S
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:53 PUTTING GREEN LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3158
Mailing Address - Country:US
Mailing Address - Phone:203-865-5111
Mailing Address - Fax:203-562-2368
Practice Address - Street 1:1308 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4515
Practice Address - Country:US
Practice Address - Phone:203-865-5111
Practice Address - Fax:203-562-2368
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT029184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT029184OtherSTATE LICENSE
CT029184OtherSTATE LICENSE
B39351Medicare UPIN