Provider Demographics
NPI:1841257508
Name:WARONSKY, ROY G (PA)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:G
Last Name:WARONSKY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 E STATESVILLE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2588
Mailing Address - Country:US
Mailing Address - Phone:704-360-8486
Mailing Address - Fax:704-230-4674
Practice Address - Street 1:400 E STATESVILLE AVE STE 20
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2581
Practice Address - Country:US
Practice Address - Phone:704-360-8486
Practice Address - Fax:704-230-4674
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102512207QA0401X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
S42985Medicare UPIN