Provider Demographics
NPI:1568974889
Name:KING, PAIGE M (PA-C)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:M
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:991 ROUTE 19 N STE B
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-9739
Mailing Address - Country:US
Mailing Address - Phone:814-877-8790
Mailing Address - Fax:814-877-8792
Practice Address - Street 1:991 ROUTE 19 N STE B
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-9739
Practice Address - Country:US
Practice Address - Phone:814-877-8790
Practice Address - Fax:814-877-8792
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059524363A00000X
PAOA004344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant