Provider Demographics
NPI:1316969686
Name:PAYNE, ALBERT EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:EDWARD
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7880 LINCOLE PL
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8322
Mailing Address - Country:US
Mailing Address - Phone:330-424-5686
Mailing Address - Fax:
Practice Address - Street 1:7880 LINCOLE PL
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8322
Practice Address - Country:US
Practice Address - Phone:330-424-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-045395207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHO504725Medicaid
OHO504725Medicaid