Provider Demographics
NPI:1689790925
Name:STATMAN, WARREN (ABO)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:
Last Name:STATMAN
Suffix:
Gender:M
Credentials:ABO
Other - Prefix:
Other - First Name:YITZCHOK
Other - Middle Name:
Other - Last Name:STATMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1268 MD RT 3 SOUTH
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1333
Mailing Address - Country:US
Mailing Address - Phone:410-721-5533
Mailing Address - Fax:410-721-5550
Practice Address - Street 1:1268 MD RT 3 SOUTH
Practice Address - Street 2:SUITE #2
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1333
Practice Address - Country:US
Practice Address - Phone:410-721-5533
Practice Address - Fax:410-721-5550
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician