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General NPI Number Information
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NPI Number | 1184019671
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH LARIVIERE MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 3400 CIVIC CENTER BLVD PCAM-2 WEST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5127
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Country | US
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Telephone | 215-615-7239
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 CIVIC CENTER BLVD PCAM-2 WEST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5127
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Country | US
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Telephone | 215-615-7239
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD471427
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License Number State | PA
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