Individual
MR. CARLTON DAMON PAIGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13111 EASTPOINT PARK BLVD, LOUISVILLE, KY 40223-4164
(502) 443-9962
(844) 300-5176
Mailing address
PO BOX 987, PEWEE VALLEY, KY 40056-0987
(502) 443-9962
(844) 300-5176
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26752
KY
208000000X
Pediatrics Physician
26752
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000298638
ANTHEM
KY
01
—
2443004000
PASSPORT ADVANTAGE
KY
01
—
50001412
PASSPORT
KY
05
—
64267529
—
KY
Enumeration date
05/05/2006
Last updated
12/01/2021
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