Healthcare Provider Details

I. General information

NPI: 1962482695
Provider Name (Legal Business Name): GLENN BARTON PAIGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CENTER ST STE 201
HICKORY NC
28601-5036
US

IV. Provider business mailing address

415 N CENTER ST STE 201
HICKORY NC
28601-5036
US

V. Phone/Fax

Practice location:
  • Phone: 828-327-8105
  • Fax: 828-327-4245
Mailing address:
  • Phone: 828-327-8105
  • Fax: 828-327-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200100585
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number200100585
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: