MEDICARE: DR. DEAN A PAGE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	21914	SC
2	208200000X	Plastic Surgery Physician	036157974	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	571096050	OTHER	SC	FEDERAL TAX ID

General Provider Information

NPI Number	:	1164491296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN A PAGE M.D.

Provider Business Mailing Address
First Line	:	3000 WOODSIDE EXECUTIVE CT
Second Line	:
City	:	AIKEN
State	:	SC
Zip	:	29803-3831
Country	:	US
Telephone Number	:	803-642-0277
Fax Number	:	803-641-4277

Provider Business Practice Location Address
First Line	:	900 W TEMPLE AVE STE 2500
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2121
Country	:	US
Telephone Number	:	217-540-2350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/28/2021

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Directions to “ DR. DEAN A PAGE M.D.” Practice Location

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