Provider Demographics
NPI:1619283421
Name:CARLOS J PAGE MD PA
Entity Type:Organization
Organization Name:CARLOS J PAGE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-783-8770
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 # 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058461400Medicaid
MD6716Medicare PIN