Provider Demographics
NPI:1841277977
Name:RACKLIFFE, PAIGE R (MD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:R
Last Name:RACKLIFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-628-6117
Mailing Address - Fax:
Practice Address - Street 1:3806 MECHANICSVILLE TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-1114
Practice Address - Country:US
Practice Address - Phone:804-228-1143
Practice Address - Fax:804-228-7382
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223492207R00000X
WI52669207R00000X
OH35082439R207R00000X
NE21173207R00000X
VA0101265772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3787226OtherAETNA US HEALTHCARE
82993OtherHEALTHY START
A38108OtherMEDICARE B
042472266OtherONE HEALTH PLAN
2104997OtherMEDICAID WELFARE
468472OtherTUFTS HEALTH PLAN
J28618OtherBLUE SHIELD INDEMNITY
J28618OtherBLUE SHIELD HMO BLUE
J28618OtherBLUE CARE ELECT
042472266OtherPRIVATE HEALTHCARE SYSTEM
MA2104997Medicaid
5134911OtherCIGNA HEALTH PLAN
042472266OtherTRICARE CHAMPUS
042472266OtherUNITED HEALTHCARE
5278213OtherFIRST HEALTH
82993OtherCHILDRENS MEDICAL SECURIT
92268OtherFALLON COMMUNITY HEALTH P
AA27643OtherHARVARD PILGRIM HEALTHCAR
MAA38108Medicare ID - Type Unspecified
MA2104997Medicaid