Healthcare Provider Details

I. General information

NPI: 1578631420
Provider Name (Legal Business Name): PAIGE TELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ROCK ROW STE 320
WESTBROOK ME
04092-4877
US

IV. Provider business mailing address

PO BOX 911
BRATTLEBORO VT
05302-0911
US

V. Phone/Fax

Practice location:
  • Phone: 207-303-3300
  • Fax: 207-250-2139
Mailing address:
  • Phone: 207-303-3200
  • Fax: 207-250-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number21056
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: