Provider Demographics
NPI:1407922529
Name:GUTHEIL, PAIGE SUZANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:SUZANNE
Last Name:GUTHEIL
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 1:5212 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1642
Mailing Address - Country:US
Mailing Address - Phone:614-878-0600
Mailing Address - Fax:614-878-1723
Practice Address - Street 1:5212 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1642
Practice Address - Country:US
Practice Address - Phone:614-878-0600
Practice Address - Fax:614-878-1723
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2606013Medicaid
OH4168931Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
OH2606013Medicaid