Provider Demographics
NPI:1336181270
Name:WARREN, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SYLVAN ST
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2763
Mailing Address - Country:US
Mailing Address - Phone:978-774-7566
Mailing Address - Fax:781-373-6690
Practice Address - Street 1:75 SYLVAN ST
Practice Address - Street 2:SUITE B-102
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2763
Practice Address - Country:US
Practice Address - Phone:978-774-7566
Practice Address - Fax:781-373-6690
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA161223207QH0002X, 207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA051947OtherHIGHMARK BLUE SHIELD
PA2512098OtherAETNA HMO
PA7260205OtherAETNA PPO
PA9402714OtherPHCS
PA17713-MD066169LOtherHEALTH PARTNERS
PA080182395OtherRRM
PA1164025OtherKEYSTONE MERCY
PA0066867000OtherIBC - PC/KHPE
PA10938422OtherCAQH ID#
PA4519969OtherCIGNA HMO/PPO
PA0182398003OtherAMERICHOICE (UHC MA PLAN)
PA0018239800004Medicaid
PA4519969OtherCIGNA HMO/PPO