Provider Demographics
NPI:1376611996
Name:MCINERNEY, PAIGE NC (DO)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:NC
Last Name:MCINERNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:PAIGE
Other - Middle Name:N
Other - Last Name:CREIGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:66 STONE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5227
Mailing Address - Country:US
Mailing Address - Phone:207-626-3455
Mailing Address - Fax:207-621-1107
Practice Address - Street 1:66 STONE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5227
Practice Address - Country:US
Practice Address - Phone:207-626-3455
Practice Address - Fax:207-621-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME20032084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432808799Medicaid