Healthcare Provider Details

I. General information

NPI: 1578742250
Provider Name (Legal Business Name): MICHAEL R. WARNER MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 THOMAS JOHNSON DR SUITE B
FREDERICK MD
21702-4384
US

IV. Provider business mailing address

63 THOMAS JOHNSON DR SUITE B
FREDERICK MD
21702-4384
US

V. Phone/Fax

Practice location:
  • Phone: 301-698-2424
  • Fax: 301-698-1018
Mailing address:
  • Phone: 301-698-2424
  • Fax: 301-698-1018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL R WARNER
Title or Position: OWNER
Credential: M.D.
Phone: 301-698-2424