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General NPI Number Information
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NPI Number | 1013030022
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Entity Type | Individual
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Provider Name | SAMEER BELLAPRAVALU MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 1 HOSPITAL DRIVE ROOM 313 PSYCHIATRY DEPT DC067.00
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City | COLUMBIA
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State | MO
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Zip | 65212-0001
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Country | US
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Telephone | 573-884-6136
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Fax | 573-884-1070
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Provider Business Mailing Address
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Address Line | 3000 STAUNTON AVE SE UNIT # 11
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City | CHARLESTON
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State | WV
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Zip | 25304-1145
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Country | US
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Telephone | 304-388-5435
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2010006687
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 2010006687
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License Number State | MO
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