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General NPI Number Information
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NPI Number | 1083795496
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Entity Type | Organization
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Legal Business Name | MALGORZATA GRADZKA, M.D., P.C.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 3620 JOSEPH SIEWICK DR SUITE 401
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City | FAIRFAX
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State | VA
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Zip | 22033-1756
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Country | US
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Telephone | 703-648-9800
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Fax | 703-648-9808
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Provider Business Mailing Address
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Address Line | PO BOX 34
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City | CABIN JOHN
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State | MD
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Zip | 20818-0034
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Country | US
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Telephone | 703-648-9800
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Fax | 703-648-9808
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MALGORZATA GRADZKA
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Credential | M.D.
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Telephone | 703-648-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 0101056754
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License Number State | VA
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