Provider Demographics
NPI:1053496323
Name:PAIGE, TARA R (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:R
Last Name:PAIGE
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 1:301 SOUTH 8TH STREET
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106
Mailing Address - Country:US
Mailing Address - Phone:215-829-5300
Mailing Address - Fax:215-829-5012
Practice Address - Street 1:301 SOUTH 8TH STREET
Practice Address - Street 2:SUITE 3D
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4035
Practice Address - Country:US
Practice Address - Phone:215-829-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06617500207V00000X
PAMD060969207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7479409Medicaid
NJG56121Medicare UPIN
NJ959056Medicare PIN