Provider Demographics
NPI:1124773809
Name:PAIGE, TYRONE M
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:M
Last Name:PAIGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ISHERWOOD ST NE APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5544
Mailing Address - Country:US
Mailing Address - Phone:202-351-7220
Mailing Address - Fax:
Practice Address - Street 1:1600 ISHERWOOD ST NE APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5544
Practice Address - Country:US
Practice Address - Phone:202-351-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant