Provider Demographics
NPI:1770137507
Name:BAROCCA, PAIGE K (CPM, LDEM)
Entity type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:K
Last Name:BAROCCA
Suffix:
Gender:F
Credentials:CPM, LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 QUEENS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1429
Mailing Address - Country:US
Mailing Address - Phone:443-907-3705
Mailing Address - Fax:
Practice Address - Street 1:6707 QUEENS FERRY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-1429
Practice Address - Country:US
Practice Address - Phone:443-907-3705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR182238163W00000X
MDDEM00021176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse