Provider Demographics
NPI:1538605647
Name:POAGE, MARIAH CARRIE (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:CARRIE
Last Name:POAGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 STUTZ DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8149
Mailing Address - Country:US
Mailing Address - Phone:330-702-1586
Mailing Address - Fax:330-702-1383
Practice Address - Street 1:3660 STUTZ DR STE 102
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8149
Practice Address - Country:US
Practice Address - Phone:330-702-1586
Practice Address - Fax:330-702-1383
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004945RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant