MEDICARE: PAIGE R RACKLIFFE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	223492	MA
2	207R00000X	Internal Medicine Physician	52669	WI
3	207R00000X	Internal Medicine Physician	35082439R	OH
4	207R00000X	Internal Medicine Physician	21173	NE
5	207R00000X	Internal Medicine Physician	0101265772	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	A38108	OTHER		MEDICARE B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	3787226	OTHER	AETNA US HEALTHCARE
2	82993	OTHER	HEALTHY START
4	042472266	OTHER	ONE HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	468472	OTHER	TUFTS HEALTH PLAN
7	J28618	OTHER	BLUE SHIELD INDEMNITY
8	J28618	OTHER	BLUE SHIELD HMO BLUE
9	J28618	OTHER	BLUE CARE ELECT
10	042472266	OTHER	PRIVATE HEALTHCARE SYSTEM
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	5134911	OTHER	CIGNA HEALTH PLAN
13	042472266	OTHER	TRICARE CHAMPUS
14	042472266	OTHER	UNITED HEALTHCARE
15	5278213	OTHER	FIRST HEALTH
16	82993	OTHER	CHILDRENS MEDICAL SECURIT
17	92268	OTHER	FALLON COMMUNITY HEALTH P
18	AA27643	OTHER	HARVARD PILGRIM HEALTHCAR

General Provider Information

NPI Number	:	1841277977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE R RACKLIFFE MD

Provider Business Mailing Address
First Line	:	1395 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5710
Country	:	US
Telephone Number	:	305-628-6117
Fax Number	:

Provider Business Practice Location Address
First Line	:	3806 MECHANICSVILLE TPKE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1114
Country	:	US
Telephone Number	:	804-228-1143
Fax Number	:	804-228-7382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	10/23/2019

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