Provider Demographics
NPI:1801113931
Name:MEIZLIK, PAIGE FORTINSKY (MD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:FORTINSKY
Last Name:MEIZLIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:M
Other - Last Name:FORTINSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-4600
Mailing Address - Fax:215-707-5599
Practice Address - Street 1:515 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034
Practice Address - Country:US
Practice Address - Phone:215-707-4600
Practice Address - Fax:215-707-5599
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447024207RE0101X, 207R00000X
PAMT197049390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program