Provider Demographics
NPI:1902847031
Name:PAIGE, ELLEN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:PAIGE
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 1:329 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-8207
Mailing Address - Country:US
Mailing Address - Phone:520-884-5249
Mailing Address - Fax:520-547-3395
Practice Address - Street 1:329 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-8207
Practice Address - Country:US
Practice Address - Phone:520-884-5249
Practice Address - Fax:520-547-3395
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18995207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00426275OtherRAILROAD MEDICARE
AZ112748Medicaid
AZZ25271Medicare PIN
AZ112748Medicaid