Provider Demographics
NPI:1801116868
Name:WARDEN, ERIC LEE (AP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
Last Name:WARDEN
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CHENOWETH DR
Mailing Address - Street 2:A
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1675
Mailing Address - Country:US
Mailing Address - Phone:304-848-0808
Mailing Address - Fax:304-265-3665
Practice Address - Street 1:7 CHENOWETH DR
Practice Address - Street 2:A
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1675
Practice Address - Country:US
Practice Address - Phone:304-848-0808
Practice Address - Fax:304-265-3665
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV96203171100000X
FLAP1513171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist