Provider Demographics
NPI:1588855993
Name:HOLDER, PAIGE N (PA)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:N
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL PARK DR
Mailing Address - Street 2:CONCORD INTERNAL & PULMONARY MEDICINE
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2982
Mailing Address - Country:US
Mailing Address - Phone:704-783-1307
Mailing Address - Fax:704-783-1090
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:CONCORD INTERNAL & PULMONARY MEDICINE
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-783-1307
Practice Address - Fax:704-783-1090
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001000993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009OtherMEDICARE