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General NPI Number Information
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NPI Number | 1295223931
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Entity Type | Organization
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Legal Business Name | MATURI MEDICAL GROUP LLC
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 2751 PROSPERITY AVE STE 440
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City | FAIRFAX
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State | VA
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Zip | 22031-4397
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Country | US
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Telephone | 703-505-0204
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Fax |
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Provider Business Mailing Address
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Address Line | 2751 PROSPERITY AVE STE 440
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City | FAIRFAX
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State | VA
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Zip | 22031-4397
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Country | US
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Telephone | 703-505-0204
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Fax |
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | MARTHA MATURI
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Credential | MD
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Telephone | 703-505-0204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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