Provider Demographics
NPI:1396859062
Name:PAGE, JOHN D (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:PAGE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0469
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:LVPG EXPRESSCARE MUHLENBERG
Practice Address - Street 2:2649 SCHOENERSVILLE ROAD SUITE 201
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7316
Practice Address - Country:US
Practice Address - Phone:484-884-8110
Practice Address - Fax:610-868-5333
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN1379363A00000X
PAMA056726363A00000X
NY021855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0025889-00Medicaid
TN62186005901OtherAMERICHOICE
TN3664980Medicaid
TN621860059OtherTRICARE
TN4151193OtherBLUE CROSS BLUE SHIELD
FLDL240ZMedicare PIN
TN3664980Medicaid