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General NPI Number Information
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NPI Number | 1285167254
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Entity Type | Individual
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Provider Name | CRAIG ROSS DO
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Gender | Male
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 111 PRESIDENTIAL BLVD SUITE 127
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1008
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Country | US
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Telephone | 484-438-5495
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Fax |
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Provider Business Mailing Address
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Address Line | 108 JOAN DR
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City | TRAPPE
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State | PA
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Zip | 19426-1957
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS-007277-L
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License Number State | PA
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