Provider Demographics
NPI:1518932789
Name:WIDMANN, WARREN D (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:D
Last Name:WIDMANN
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:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1348
Mailing Address - Country:US
Mailing Address - Phone:973-644-4844
Mailing Address - Fax:973-644-4776
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:CAROL G. SIMON CANCER CENTER
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-644-4844
Practice Address - Fax:973-644-4776
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA023705208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0773905Medicaid
NJ565605RWMMedicare ID - Type Unspecified
NJC53991Medicare UPIN