Provider Demographics
NPI:1508946468
Name:PAGE, CARLOS J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:PAGE
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 1:301 SAINT PAUL PL # 818
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-783-8770
Mailing Address - Fax:410-625-5885
Practice Address - Street 1:301 SAINT PAUL PL STE 818
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-783-8770
Practice Address - Fax:410-625-5885
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058461400Medicaid
MD058461400Medicaid
MD6716Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER