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General NPI Number Information
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NPI Number | 1144706979
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Entity Type | Individual
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Provider Name | SREELAKSHMI KOORAGAYALU MD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2018
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 12500 WILLOWBROOK RD
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City | CUMBERLAND
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State | MD
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Zip | 21502-6393
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Country | US
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Telephone | 240-964-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 16902 MOUNTAIN CLUB AVE
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City | RAWLINGS
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State | MD
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Zip | 21557-1041
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Country | US
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Telephone | 929-313-4430
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 22596
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0090518
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License Number State | MD
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