Provider Demographics
NPI:1750331336
Name:WARREN, CYNTHIA COLLIER (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:COLLIER
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 GREEN BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1511
Mailing Address - Country:US
Mailing Address - Phone:215-572-1313
Mailing Address - Fax:
Practice Address - Street 1:1740 SOUTH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1514
Practice Address - Country:US
Practice Address - Phone:215-735-5600
Practice Address - Fax:215-735-5690
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055124L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015241940007Medicaid
PAG24465Medicare UPIN
PA0015241940007Medicaid