Healthcare Provider Details

I. General information

NPI: 1265068662
Provider Name (Legal Business Name): PAIGE OWENS DOWNING DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19900 MUNNS CORNER RD
FORT DRUM NY
13603
US

IV. Provider business mailing address

19900 MUNNS CORNER RD
FORT DRUM NY
13603
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-5513
  • Fax:
Mailing address:
  • Phone: 315-772-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102207077
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: