Provider Demographics
NPI:1821081126
Name:WARREN, STAFFORD GAY (MD)
Entity Type:Individual
Prefix:MR
First Name:STAFFORD
Middle Name:GAY
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:888 BESTGATE RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3091
Mailing Address - Country:US
Mailing Address - Phone:410-573-9805
Mailing Address - Fax:410-573-9806
Practice Address - Street 1:888 BESTGATE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3091
Practice Address - Country:US
Practice Address - Phone:410-573-9805
Practice Address - Fax:410-573-9806
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10260207RI0011X
MDD0067661207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417655300Medicaid
A72609Medicare UPIN
MD417655300Medicaid