Healthcare Provider Details

I. General information

NPI: 1295218246
Provider Name (Legal Business Name): PAIGE HOBAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE STANLEY PA-C

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5189
US

IV. Provider business mailing address

3500 N BROAD ST # 1A
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-5864
  • Fax: 215-707-6867
Mailing address:
  • Phone: 215-707-5864
  • Fax: 215-707-6867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060132
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: