Provider Demographics
NPI:1770503849
Name:WARREN, VAN D (MD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:D
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-060476207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2059069OtherAETNA
OH990011612OtherRAILROAD MEDICARE
OH000000224341OtherUNISON
OH364112OtherWELLCARE
OH000000539616OtherANTHEM
OHP00427402OtherRAILROAD MEDICARE
OH0816933Medicaid
OH743437OtherBUCKEYE
OH000000224341OtherUNISON
E75567Medicare UPIN
OHWA0682295Medicare PIN