1750688438 NPI number — LS OF RALEIGH

Table of content: DR. SARAH ELIZABETH PAGE M.D. (NPI 1326185380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750688438 NPI number — LS OF RALEIGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LS OF RALEIGH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750688438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10208 CERNY ST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27617-7884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10208 CERNY ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27617-7884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-457-0340
Provider Business Practice Location Address Fax Number:
919-806-2123
Provider Enumeration Date:
02/16/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPADUZZI
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CENTER OPERATIONS
Authorized Official Telephone Number:
919-457-0340

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  200100941 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)