Provider Demographics
NPI:1790779254
Name:WARREN, BRENT BLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:BLAIR
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-838-8494
Practice Address - Street 1:646 HARTNESS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3423
Practice Address - Country:US
Practice Address - Phone:704-872-4108
Practice Address - Fax:704-873-6517
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200301426207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2407151OtherUNITED HEALTHCARE
NC136WPOtherBCBSNC
SC000000295044OtherUNISON HEALTH PLAN SC
NC188941OtherMEDCOST
7833504OtherAETNA
P00292839OtherRAILROAD MEDICARE
SCG0142BMedicaid
SC81900OtherCHCARES OF SC
SC20096157OtherSELECT HEALTH OF SC
NC89136WPMedicaid
NCH45099Medicare UPIN
NC136WPOtherBCBSNC
SC81900OtherCHCARES OF SC