Provider Demographics
NPI:1336216019
Name:WARREN, MATTHEW SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
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 1:81 S MAIN ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2405
Mailing Address - Country:US
Mailing Address - Phone:860-521-4044
Mailing Address - Fax:860-521-3885
Practice Address - Street 1:81 S MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2400
Practice Address - Country:US
Practice Address - Phone:860-521-4044
Practice Address - Fax:860-521-3885
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008002771Medicaid
CT008002771Medicaid