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General NPI Number Information
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NPI Number | 1114527876
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Entity Type | Individual
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Provider Name | BALASUBRAMANIAN VAITILINGAM PHD
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Gender | Male
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 3579 S HIGH ST
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City | COLUMBUS
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State | OH
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Zip | 43207-4008
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Country | US
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Telephone | 614-409-0689
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Fax |
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Provider Business Mailing Address
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Address Line | 6692 ROCKY RIDGE DR
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City | POWELL
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State | OH
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Zip | 43065-9382
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Country | US
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Telephone | 765-586-8001
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03132259
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License Number State | OH
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