Provider Demographics
NPI:1982640702
Name:WARNOCK, PRISCILLA LYDIA (MD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:LYDIA
Last Name:WARNOCK
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:PO BOX 64042
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8601 VETERANS HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1547
Practice Address - Country:US
Practice Address - Phone:410-729-0424
Practice Address - Fax:410-729-0492
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6002OtherBRAVO/ELDER HEALTH
MD69933OtherAMERIGROUP
MD970006233 CC0691OtherRR MEDICARE
MDCC0691Medicare PIN
MDK365 855VMedicare PIN