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General NPI Number Information
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NPI Number | 1144769530
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Entity Type | Organization
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Legal Business Name | MICHAEL R. SIMMONS, MD
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 57 W TIMONIUM RD SUITE 208
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City | TIMONIUM
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State | MD
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Zip | 21093-3125
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Country | US
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Telephone | 410-252-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 57 W TIMONIUM RD SUITE 208
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City | TIMONIUM
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State | MD
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Zip | 21093-3125
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL R SIMMONS
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Credential |
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Telephone | 410-252-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | D0030190
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License Number State | MD
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