MEDICARE: STEPHANIE DIANA WARRINGTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	66160	AZ
2	207YS0123X	Facial Plastic Surgery Physician	66160	AZ
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207Y00000X	Otolaryngology Physician	0101271992	VA

General Provider Information

NPI Number	:	1780046631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DIANA WARRINGTON MD

Provider Business Mailing Address
First Line	:	4530 E SHEA BLVD STE 180
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6042
Country	:	US
Telephone Number	:	602-264-4834
Fax Number	:	602-257-8319

Provider Business Practice Location Address
First Line	:	5750 W THUNDERBIRD RD STE A100
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4661
Country	:	US
Telephone Number	:	602-938-3205
Fax Number	:	602-938-5799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	07/28/2022

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