Provider Demographics
NPI:1033505292
Name:PHILLIPS, PAIGE TENNEY (MD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:TENNEY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11258 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2214
Mailing Address - Country:US
Mailing Address - Phone:513-563-0044
Mailing Address - Fax:513-563-0061
Practice Address - Street 1:11258 LEBANON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241
Practice Address - Country:US
Practice Address - Phone:513-563-0044
Practice Address - Fax:513-563-0061
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-133566208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics