Provider Demographics
NPI:1093715914
Name:CARRINGTON, EDWARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:CARRINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 S DOBSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6457
Mailing Address - Country:US
Mailing Address - Phone:480-912-3510
Mailing Address - Fax:480-912-3514
Practice Address - Street 1:2204 S DOBSON RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6457
Practice Address - Country:US
Practice Address - Phone:480-912-3510
Practice Address - Fax:480-912-3514
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0100151OtherUNITED HEALTHCARE
AZ21079227OtherICA
AZ4057973OtherAETNA
AZ080194927OtherMEDICARE RAILROAD
AZ2400601JOtherDES
AZZA0361080OtherBLUE CROSS/BLUE SHIELD
AZ00140106OtherBANNER
AZ1078501OtherCIGNA HEALTHCARE
AZ1078501OtherCIGNA HEALTHCARE
AZZWDBFV01Medicare ID - Type UnspecifiedMEDICARE ID