Provider Demographics
NPI:1417905795
Name:PAIGE, CARLTON DAMON (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:DAMON
Last Name:PAIGE
Suffix:
Gender:M
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:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:PEWEE VALLEY
Mailing Address - State:KY
Mailing Address - Zip Code:40056-0987
Mailing Address - Country:US
Mailing Address - Phone:502-443-9962
Mailing Address - Fax:844-300-5176
Practice Address - Street 1:13111 EASTPOINT PARK BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4164
Practice Address - Country:US
Practice Address - Phone:502-443-9962
Practice Address - Fax:844-300-5176
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26752207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50001412OtherPASSPORT
KY2443004000OtherPASSPORT ADVANTAGE
KY64267529Medicaid
KY000000298638OtherANTHEM
KY000000298638OtherANTHEM
KYF17090Medicare UPIN
KY64267529Medicaid