Provider Demographics
NPI:1477106615
Name:LAMICA, PAIGE A
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:A
Last Name:LAMICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MAIN ST
Mailing Address - Street 2:STE 165
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-3609
Mailing Address - Country:US
Mailing Address - Phone:617-209-7823
Mailing Address - Fax:
Practice Address - Street 1:189 WILLARD ST APT 105
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4939
Practice Address - Country:US
Practice Address - Phone:774-402-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant