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General NPI Number Information
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NPI Number | 1124224514
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Entity Type | Organization
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Legal Business Name | JAY C TYROLER M.D.,P.C.
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 3620 JOSEPH SIEWICK DR SUITE 306
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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 | 703-264-0521
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Fax | 703-860-0229
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Provider Business Mailing Address
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Address Line | 3620 JOSEPH SIEWICK DR SUITE 306
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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 | 703-264-0521
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Fax | 703-860-0229
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Authorized Official
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Title or Position | PRINCIPAL HOLDER
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Name | DR. JAY CARY TYROLER
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Credential | M.D.
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Telephone | 703-264-0521
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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 | 0101049092
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License Number State | VA
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