Provider Demographics
NPI:1548228489
Name:WARREN, WILBERT ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILBERT
Middle Name:ROY
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1740 SOUTH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1514
Mailing Address - Country:US
Mailing Address - Phone:215-732-0876
Mailing Address - Fax:215-732-4162
Practice Address - Street 1:1740 SOUTH ST
Practice Address - Street 2:STE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1514
Practice Address - Country:US
Practice Address - Phone:215-732-0876
Practice Address - Fax:215-732-4162
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058046-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016252300010Medicaid
PAG34781Medicare UPIN
PA0016252300010Medicaid