Healthcare Provider Details

I. General information

NPI: 1811044571
Provider Name (Legal Business Name): PAIGE MARIE PORRETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/01/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET 4 SILVERSTEIN
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE STREET 4 SILVERSTEIN
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-4949
  • Fax: 215-662-2244
Mailing address:
  • Phone: 215-615-4949
  • Fax: 215-662-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41179
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD424625
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: