Provider Demographics
NPI:1861579021
Name:RADELL, PAIGE (MD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:RADELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 PUTNAM BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4686
Mailing Address - Country:US
Mailing Address - Phone:925-391-9439
Mailing Address - Fax:
Practice Address - Street 1:3147 PUTNAM BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4686
Practice Address - Country:US
Practice Address - Phone:925-391-9439
Practice Address - Fax:925-386-3059
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80594207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI08520Medicare UPIN
CA00A805940Medicare ID - Type Unspecified