Provider Demographics
NPI:1710026687
Name:WARRENTON MEDICAL ASSOCIATES,PC
Entity Type:Organization
Organization Name:WARRENTON MEDICAL ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MAURONER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:540-347-5512
Mailing Address - Street 1:555 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3028
Mailing Address - Country:US
Mailing Address - Phone:540-347-5512
Mailing Address - Fax:540-341-4646
Practice Address - Street 1:555 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3028
Practice Address - Country:US
Practice Address - Phone:540-347-5512
Practice Address - Fax:540-341-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA274673OtherANTHEM GROUP NUMBER
VA=========OtherTAX IDENTIFICATION NUMBER
VA=========OtherTAX IDENTIFICATION NUMBER