RANDY L WARREN MD PLLC
Psychiatric at Maccorkle Ave, Charleston, WV

License number
West Virginia 21827
Category
Psychiatric
Type
Psychiatry
Owner
Name: DR. RANDY L WARREN M.D.
Title: OWNER/MEMBER
Phone: (304) 766-6666
Address
Address
4501 Maccorkle Ave SW SUITE 202, Charleston, WV 25309
National Provider ID: 1053583575
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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RANDY L WARREN, M.D. PLLC

Charleston, WV

Status:
Inactive
Inactive reason:
Revoked (Failure to File Annual Report)
Registration:
Dec 21, 2007
Inactive since:
Dec 21, 2012
Addresses:
4501 Maccorkle Ave SW SUITE 202, Charleston, WV 25309 (Mailing)
Randy L Warren, Charleston, WV 25309 (Physical)
Business type:
Professional Limited Liability Company
Member:
Md Randy L Warren (Member), 4501 Maccorkle Ave SW SUITE 202, Charleston, WV 25309

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