Provider Demographics
NPI:1487214235
Name:PROCTOR, PAIGE C (PA)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:C
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:PAIGE
Other - Middle Name:C
Other - Last Name:FEDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1309 JAMESTOWN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3380
Mailing Address - Country:US
Mailing Address - Phone:833-516-0454
Mailing Address - Fax:
Practice Address - Street 1:1309 JAMESTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3380
Practice Address - Country:US
Practice Address - Phone:833-516-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006708363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical