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General NPI Number Information
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NPI Number | 1043477045
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Entity Type | Organization
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Legal Business Name | VASECTOMY CENTER OF CONNECTICUT, LLC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 2800 TAMARACK RD SUITE 108
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-5539
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Country | US
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Telephone | 860-430-5773
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Fax | 860-430-5773
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | EAST GLASTONBURY
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State | CT
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Zip | 06025-0010
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Country | US
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Telephone | 860-430-5773
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Fax | 860-430-5773
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT DANIEL MATSON
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Credential | M.D.
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Telephone | 860-430-5773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 040285
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License Number State | CT
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