Provider Demographics
NPI:1487640041
Name:WARNER, JEAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:K
Last Name:WARNER
Suffix:
Gender:F
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:PO BOX 404442
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4442
Mailing Address - Country:US
Mailing Address - Phone:804-756-5130
Mailing Address - Fax:
Practice Address - Street 1:8601 VETERANS HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1547
Practice Address - Country:US
Practice Address - Phone:410-729-4451
Practice Address - Fax:410-729-4470
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00506742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKZ42 54313135OtherCAREFIRST BCBS
MD110800000 529868700Medicaid
DC3811 0037OtherCAREFIRST BCBS
MDH380K826Medicare PIN
MD110800000 529868700Medicaid
MD865LK827Medicare PIN
MDG14673Medicare UPIN