Healthcare Provider Details

I. General information

NPI: 1962907089
Provider Name (Legal Business Name): PAIGE TAYLOR AUSTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 PARMALEE AVE STE 510
YOUNGSTOWN OH
44510-1605
US

IV. Provider business mailing address

540 PARMALEE AVE STE 510
YOUNGSTOWN OH
44510-1605
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-1928
  • Fax: 330-744-2110
Mailing address:
  • Phone: 330-743-1928
  • Fax: 330-744-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005502RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: