Basic Information
| Provider Information | |||||||||
| NPI: | 1841277977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RACKLIFFE | ||||||||
| FirstName: | PAIGE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056286117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3806 MECHANICSVILLE TPKE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232231114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042281143 | ||||||||
| FaxNumber: | 8042287382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 223492 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 52669 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35082439R | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 21173 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101265772 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3787226 | 01 | AETNA US HEALTHCARE | OTHER | 82993 | 01 | HEALTHY START | OTHER | A38108 | 01 | MEDICARE B | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 2104997 | 01 | MEDICAID WELFARE | OTHER | 468472 | 01 | TUFTS HEALTH PLAN | OTHER | J28618 | 01 | BLUE SHIELD INDEMNITY | OTHER | J28618 | 01 | BLUE SHIELD HMO BLUE | OTHER | J28618 | 01 | BLUE CARE ELECT | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 2104997 | 05 | MA | MEDICAID | 5134911 | 01 | CIGNA HEALTH PLAN | OTHER | 042472266 | 01 | TRICARE CHAMPUS | OTHER | 042472266 | 01 | UNITED HEALTHCARE | OTHER | 5278213 | 01 | FIRST HEALTH | OTHER | 82993 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 92268 | 01 | FALLON COMMUNITY HEALTH P | OTHER | AA27643 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER |