Provider Demographics
NPI:1093740383
Name:PAGE, ALEX (DO)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 NAZARETH RD
Mailing Address - Street 2:
Mailing Address - City:PALMER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2096
Mailing Address - Country:US
Mailing Address - Phone:610-559-2060
Mailing Address - Fax:610-559-2064
Practice Address - Street 1:3213 NAZARETH RD
Practice Address - Street 2:
Practice Address - City:PALMER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18045-2096
Practice Address - Country:US
Practice Address - Phone:610-559-2060
Practice Address - Fax:610-559-2064
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103015Medicare PIN