Provider Demographics
NPI:1245270131
Name:WARREN, GREG A (DO)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:A
Last Name:WARREN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HASTINGS LANE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3324
Mailing Address - Country:US
Mailing Address - Phone:252-335-1083
Mailing Address - Fax:252-335-4030
Practice Address - Street 1:206 HASTINGS LANE
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3324
Practice Address - Country:US
Practice Address - Phone:252-335-1083
Practice Address - Fax:252-335-4030
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142EROtherBLUE CROSS BLUE SHIELD
NC5903364Medicaid
NCP00391176OtherRAIL ROAD MEDICARE
NCI60618Medicare UPIN
NC142EROtherBLUE CROSS BLUE SHIELD