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General NPI Number Information
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NPI Number | 1134234198
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Entity Type | Individual
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Provider Name | ALIA GOODHEART M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 33 NAGOG PARK STE 215
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City | ACTON
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State | MA
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Zip | 01720-3427
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Country | US
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Telephone | 508-834-3183
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Fax | 508-532-1168
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Provider Business Mailing Address
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Address Line | 4 GARDEN WAY
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City | MAYNARD
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State | MA
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Zip | 01754-1100
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Country | US
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Telephone | 617-650-3324
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 220407
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License Number State | MA
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