Provider Demographics
NPI:1821159070
Name:WARDEN, JAMES RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:WARDEN
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 1:3211 LIBERTY ST
Mailing Address - Street 2:SUITE302
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2575
Mailing Address - Country:US
Mailing Address - Phone:814-864-7093
Mailing Address - Fax:814-864-9025
Practice Address - Street 1:3211 LIBERTY ST
Practice Address - Street 2:SUITE302
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2575
Practice Address - Country:US
Practice Address - Phone:814-864-7093
Practice Address - Fax:814-864-9025
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD01563E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA166042Medicaid
PAC32444Medicare UPIN
PA162208Medicare ID - Type Unspecified