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General NPI Number Information
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NPI Number | 1184449357
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Entity Type | Organization
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Legal Business Name | INFUSION WAVE LLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 20 RIDGELY AVE STE 307
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1426
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Country | US
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Telephone | 443-510-1198
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Fax |
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Provider Business Mailing Address
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Address Line | 20 RIDGELY AVE STE 307
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1426
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Country | US
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Telephone | 443-510-1198
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. NOAH STROTHER
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Credential |
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Telephone | 443-440-0603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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