Provider Demographics
NPI:1043285364
Name:HAGE, SUSAN M (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:HAGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BATES ST
Mailing Address - Street 2:STE 102 MEDICAL REHABILITATION ASSOCIATES
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240
Mailing Address - Country:US
Mailing Address - Phone:207-783-2300
Mailing Address - Fax:207-783-2439
Practice Address - Street 1:77 BATES ST
Practice Address - Street 2:STE 102 MEDICAL REHAB ASSOCIATES
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-783-2300
Practice Address - Fax:207-783-2439
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME01676208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
010424957OtherEMPLOY STANDARDS
010424957OtherCHAMPUS
010424957OtherTRICARE
80672OtherHARVARD PILGRIM
042094OtherBCBS
010424957OtherSTANDARD TAX ID
250014126OtherMEDICARE RAILROAD
010424957OtherCIGNA
3032661OtherAETNA
ME325310099Medicaid
3032661OtherAETNA
042094OtherBCBS