Provider Demographics
NPI:1235669474
Name:MCLEAN DIAZ, PAIGE (MD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:MCLEAN DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:O
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DEPT 3010, PO 986524
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6524
Mailing Address - Country:US
Mailing Address - Phone:833-924-5546
Mailing Address - Fax:
Practice Address - Street 1:375 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2232
Practice Address - Country:US
Practice Address - Phone:401-649-4030
Practice Address - Fax:401-649-4031
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
RIMD19702207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program