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General NPI Number Information
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NPI Number | 1215004718
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Entity Type | Individual
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Provider Name | DERMOT NICHOLAS KILLIAN MD
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-2075
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Fax | 757-953-0832
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Provider Business Mailing Address
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Address Line | 2112 SOUNDINGS CRESCENT CT
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City | SUFFOLK
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State | VA
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Zip | 23435-3737
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Country | US
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Telephone | 757-953-2075
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Fax | 757-953-0832
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 008344
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License Number State | ME
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