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General NPI Number Information
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NPI Number | 1306839469
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Entity Type | Individual
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Provider Name | CARLOS EUGENIO COVARRUBIAS PONCE MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 8121 GEORGIA AVE SUITE 405
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City | SILVER SPRING
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State | MD
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Zip | 20910-4933
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Country | US
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Telephone | 301-589-9480
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Fax | 301-589-3872
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Provider Business Mailing Address
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Address Line | 8121 GEORGIA AVE SUITE 405
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City | SILVER SPRING
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State | MD
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Zip | 20910-4933
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Country | US
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Telephone | 301-589-9480
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Fax | 301-589-3872
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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 | D0048290
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License Number State | MD
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