Provider Demographics
NPI:1720023351
Name:WARREN OTOLOGIC GROUP, INC
Entity Type:Organization
Organization Name:WARREN OTOLOGIC GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:LIPPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-856-4000
Mailing Address - Street 1:3893 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4706
Mailing Address - Country:US
Mailing Address - Phone:330-856-4000
Mailing Address - Fax:330-609-9910
Practice Address - Street 1:3893 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4706
Practice Address - Country:US
Practice Address - Phone:330-856-4000
Practice Address - Fax:330-609-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207KA0200X, 207Y00000X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092457Medicaid
OHWA9208981Medicare ID - Type UnspecifiedOHIO MEDICARE PROVIDER