Healthcare Provider Details

I. General information

NPI: 1255827325
Provider Name (Legal Business Name): TAREVA WARRICK-STONE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 CHESTNUT ST STE 1020
PHILADELPHIA PA
19107-4310
US

IV. Provider business mailing address

1015 CHESTNUT ST STE 1020
PHILADELPHIA PA
19107-4310
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-0030
  • Fax:
Mailing address:
  • Phone: 215-955-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS020330
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS020330
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: