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General NPI Number Information
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NPI Number | 1134112428
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Entity Type | Individual
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Provider Name | BLAINE E SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 8601 VETERANS HWY SUITE 100
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City | MILLERSVILLE
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State | MD
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Zip | 21108-1547
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Country | US
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Telephone | 410-729-4451
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Fax | 410-729-4470
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Provider Business Mailing Address
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Address Line | PO BOX 404442
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City | ATLANTA
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State | GA
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Zip | 30384-4442
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Country | US
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Telephone | 804-756-5130
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Fax | 804-672-6899
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | D0021406
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License Number State | MD
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