Provider Demographics
NPI:1578631420
Name:TELLER, PAIGE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:
Last Name:TELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 CAMPUS DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7171
Mailing Address - Country:US
Mailing Address - Phone:207-396-7788
Mailing Address - Fax:207-396-8500
Practice Address - Street 1:100 CAMPUS DR
Practice Address - Street 2:SUITE 121
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7171
Practice Address - Country:US
Practice Address - Phone:207-396-7788
Practice Address - Fax:207-396-8500
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME210562086X0206X
MA2501002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0025949Medicare PIN