Provider Demographics
NPI:1669478285
Name:WARREN, WILLIAM ADDISON (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ADDISON
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8871 GORMAN ROAD
Mailing Address - Street 2:STE 300
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723
Mailing Address - Country:US
Mailing Address - Phone:301-498-3150
Mailing Address - Fax:301-490-2411
Practice Address - Street 1:8871 GORMAN ROAD
Practice Address - Street 2:STE 300
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723
Practice Address - Country:US
Practice Address - Phone:301-498-3150
Practice Address - Fax:301-490-2411
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD13916207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC80160003OtherBLUE SHIELD NATIONAL AREA
MD411701800Medicaid
MD36778001OtherBLUE SHIELD OF MD
MD411701800Medicaid
MDD09329Medicare UPIN