Provider Demographics
NPI:1700187143
Name:PAIGE, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:PAIGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 HUDSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210
Mailing Address - Country:US
Mailing Address - Phone:518-495-2286
Mailing Address - Fax:518-462-5889
Practice Address - Street 1:374 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12210-1003
Practice Address - Country:US
Practice Address - Phone:518-495-2286
Practice Address - Fax:518-462-5889
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor