Provider Demographics
NPI:1184987877
Name:GAGE, COLIN HAYES (PA-C)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:HAYES
Last Name:GAGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 WORLD TRADE BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4202
Mailing Address - Country:US
Mailing Address - Phone:630-740-0574
Mailing Address - Fax:
Practice Address - Street 1:6402 MCCRIMMON PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8139
Practice Address - Country:US
Practice Address - Phone:919-655-1000
Practice Address - Fax:919-655-1010
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04941363A00000X
SCTL 1789363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC461555OtherGROUP MEDICARE DME #
SCCD28777OtherGROUP MEDICARE RAILROAD #
SC20076508OtherGROUP SELECT HEALTH DME #
SC1225006760OtherGROUP NPI #
SC1326287434OtherGROUP MEDICARE DME NPI #
SCPA0971OtherGROUP MEDICAID #
SC20000499OtherGROUP SELECT HEALTH PROVIDER #
SC57-0634057OtherGROUP TAX ID #
SC1701OtherGROUP MEDICARE PIN #
SC042299001OtherGROUP DMERC #