Healthcare Provider Details

I. General information

NPI: 1700865011
Provider Name (Legal Business Name): SOPHIA LORRAINE PAIGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 SPRINGBANK LN SUITE B
CHARLOTTE NC
28226-3345
US

IV. Provider business mailing address

3125 SPRINGBANK LN SUITE B
CHARLOTTE NC
28226-3345
US

V. Phone/Fax

Practice location:
  • Phone: 704-341-1103
  • Fax: 704-341-3460
Mailing address:
  • Phone: 704-341-1103
  • Fax: 704-341-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9600668
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: