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General NPI Number Information
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NPI Number | 1225217763
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Entity Type | Organization
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Legal Business Name | DAVID A. EDMONSON, M.D., PC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 319 S MANNING BLVD SUITE 210
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City | ALBANY
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State | NY
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Zip | 12208-1742
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Country | US
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Telephone | 518-641-6936
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Fax | 518-641-6939
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Provider Business Mailing Address
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Address Line | PO BOX 194
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City | ALBANY
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State | NY
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Zip | 12201-0194
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Country | US
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Telephone | 518-641-6936
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Fax | 518-641-6939
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. DAVID A EDMONSON
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Credential | MD
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Telephone | 518-641-6936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 236674-1
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License Number State | NY
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