Individual
DR. OTIS UPSON WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD12935
RI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
A98804
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001187301
MEDICARE
RI
01
—
07/30/2009
BCBS
RI
01
—
08/01/2009
UNITED HEALTHCARE
RI
01
—
08/13/2009
NHPRI
RI
01
—
09/22/2009
TUFTS HEALTH PLAN
MA
05
—
11082647A
—
MA
01
—
1962455022
UEMF GROUP NPI
RI
01
—
939025129
MEDICARE GROUP NUMBER
RI
05
—
OW76308
—
RI
Enumeration date
07/12/2008
Last updated
02/05/2010
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