Healthcare Provider Details

I. General information

NPI: 1811574098
Provider Name (Legal Business Name): KRISTEN PAIGE PACIFIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N EWING ST
LANCASTER OH
43130-3372
US

IV. Provider business mailing address

PO BOX 951107
CLEVELAND OH
44193-0005
US

V. Phone/Fax

Practice location:
  • Phone: 800-548-2627
  • Fax:
Mailing address:
  • Phone: 866-406-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number35.156946
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: