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General NPI Number Information
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NPI Number | 1003366618
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Entity Type | Organization
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Legal Business Name | BLUEFIELD VASCULAR CENTER
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 970 LEATHERWOOD LN
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City | BLUEFIELD
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State | VA
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Zip | 24605-2047
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Country | US
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Telephone | 304-582-0888
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Fax | 304-582-0877
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Provider Business Mailing Address
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Address Line | PO BOX 1557
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City | BLUEFIELD
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State | WV
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Zip | 24701-1557
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Country | US
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Telephone | 276-582-0888
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Fax | 276-582-0877
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Authorized Official
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Title or Position | OWNER
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Name | SUMAN VARDAN
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Credential | M.D.
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Telephone | 276-582-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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