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General NPI Number Information
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NPI Number | 1295717601
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Entity Type | Organization
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Legal Business Name | LEBANON MEDICAL CENTER, INC
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Dates
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Enumeration Date | 11/20/2005
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Last Update Date | 05/12/2012
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Provider Practice Location Address
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Address Line | 990 BELVEDERE DR STE A
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City | LEBANON
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State | OH
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Zip | 45036-2890
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Country | US
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Telephone | 513-228-1666
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Fax | 513-228-1555
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Provider Business Mailing Address
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Address Line | 7661 BROOKFARM CT
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City | MASON
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State | OH
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Zip | 45040-7027
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Country | US
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Telephone | 513-398-7376
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MADHUMATHI KOSARAJU
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Credential | M.D.
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Telephone | 513-228-1666
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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 | 207R00000X
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License Number State | OH
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