Provider Demographics
NPI:1649320003
Name:WARREN SURGEONS, INC.
Entity type:Organization
Organization Name:WARREN SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCAFOOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-723-2770
Mailing Address - Street 1:103 W SAINT CLAIR ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2197
Mailing Address - Country:US
Mailing Address - Phone:814-723-2770
Mailing Address - Fax:814-723-0787
Practice Address - Street 1:103 W SAINT CLAIR ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2197
Practice Address - Country:US
Practice Address - Phone:814-723-2770
Practice Address - Fax:814-723-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-032638E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWA094003Medicare ID - Type Unspecified