Provider Demographics
NPI:1790756989
Name:PAGE, PAUL F (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:PAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 HOMEPLACE DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7158
Mailing Address - Country:US
Mailing Address - Phone:540-375-9420
Mailing Address - Fax:
Practice Address - Street 1:22890 VIRGIL GOODE HWY
Practice Address - Street 2:
Practice Address - City:BOONES MILL
Practice Address - State:VA
Practice Address - Zip Code:24065
Practice Address - Country:US
Practice Address - Phone:540-334-5511
Practice Address - Fax:540-334-3174
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-037968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6092837Medicaid
B06440Medicare UPIN