Provider Demographics
NPI:1730120742
Name:WARSHAW, NEAL (PA-C)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:WARSHAW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-2148
Mailing Address - Country:US
Mailing Address - Phone:419-528-2418
Mailing Address - Fax:413-528-2907
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2148
Practice Address - Country:US
Practice Address - Phone:419-528-2418
Practice Address - Fax:413-528-2907
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2273363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY361107OtherMVP
NYS10607Medicare UPIN
MAAP2273Medicare PIN