Provider Demographics
NPI:1912147919
Name:COLON, PAGE VICTORIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PAGE
Middle Name:VICTORIA
Last Name:COLON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:VICTORIA
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:12265 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1201
Mailing Address - Country:US
Mailing Address - Phone:215-856-1010
Mailing Address - Fax:
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-947-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003207L363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical