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General NPI Number Information
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NPI Number | 1225459936
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Entity Type | Organization
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Legal Business Name | CENTER FOR SPORTS AND REGENERATIVE ORTHOPEDICS, LLC
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 601 POST OFFICE RD STE 2A
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City | WALDORF
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State | MD
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Zip | 20602
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Country | US
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Telephone | 240-754-7954
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Fax | 240-754-7958
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Provider Business Mailing Address
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Address Line | 601 POST OFFICE RD STE 2A
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City | WALDORF
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State | MD
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Zip | 20602-1912
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Country | US
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Telephone | 240-754-7954
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Fax | 240-754-7958
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MIRIAM RAZAQ
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Credential | M.D.
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Telephone | 240-754-7954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | H67340
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License Number State | MD
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