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General NPI Number Information
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NPI Number | 1154309094
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Entity Type | Individual
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Provider Name | TARA L CHRONISTER MD
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Gender | Female
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Dates
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Enumeration Date | 01/01/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 920 CHURCH ST N
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City | CONCORD
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State | NC
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Zip | 28025-2927
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Country | US
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Telephone | 704-783-3426
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Fax |
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Provider Business Mailing Address
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Address Line | 804 SCOTT NIXON MEMORIAL DR
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City | AUGUSTA
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State | GA
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Zip | 30907-2464
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Country | US
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Telephone | 800-394-4445
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 9700035
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License Number State | MD
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