Provider Demographics
NPI:1619218823
Name:GRODIN, WARREN KEITH (MD)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:KEITH
Last Name:GRODIN
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 1:3 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1227
Mailing Address - Country:US
Mailing Address - Phone:845-323-3848
Mailing Address - Fax:845-353-2502
Practice Address - Street 1:3 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1227
Practice Address - Country:US
Practice Address - Phone:845-323-3848
Practice Address - Fax:845-353-2502
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133869207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology