Provider Demographics
NPI:1609117746
Name:WARLICK, RUSSELL AARON (IDC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:AARON
Last Name:WARLICK
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 MIDWAY RD
Mailing Address - Street 2:STE 600
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-9302
Mailing Address - Country:US
Mailing Address - Phone:757-462-2187
Mailing Address - Fax:
Practice Address - Street 1:2520 MIDWAY RD
Practice Address - Street 2:STE 600
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-9302
Practice Address - Country:US
Practice Address - Phone:757-462-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman