Provider Demographics
NPI:1649765777
Name:WHITTAKER, PAIGE ANITA (PA)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ANITA
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WAUREGAN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-1926
Mailing Address - Country:US
Mailing Address - Phone:774-276-2797
Mailing Address - Fax:
Practice Address - Street 1:85 RETREAT AVENUE
Practice Address - Street 2:HARTFORD HOSPITAL CANCER CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2555
Practice Address - Country:US
Practice Address - Phone:860-972-4183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6609363A00000X
CT005573363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant