Provider Demographics
NPI:1679531487
Name:WARNER, MARK F (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:WARNER
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 1:7001 FOREST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-288-3123
Mailing Address - Fax:804-288-6591
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-288-3123
Practice Address - Fax:804-288-6591
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032153174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA060070147OtherRAILROAD MEDICARE
VA288833OtherANTHEM BLUE SHIELD
VA005881561Medicaid
VA020805B62Medicare PIN
VA288833OtherANTHEM BLUE SHIELD