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General NPI Number Information
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NPI Number | 1003283938
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Entity Type | Organization
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Legal Business Name | MID ATLANTIC PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 3930 PENDER DR SUITE 120
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City | FAIRFAX
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State | VA
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Zip | 22030-0985
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Country | US
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Telephone | 301-829-7693
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Fax | 301-829-7694
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Provider Business Mailing Address
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Address Line | 1302 RISING RIDGE RD SUITE 1
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City | MOUNT AIRY
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State | MD
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Zip | 21771-5790
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Country | US
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Telephone | 301-829-7683
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Fax | 301-829-7694
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Authorized Official
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Title or Position | COO
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Name | LEWIE G ANDERSON
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Credential |
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Telephone | 301-829-7683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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