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General NPI Number Information
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NPI Number | 1316030521
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Entity Type | Organization
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Legal Business Name | MANSFIELD DERMATOLOGY INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 161 CLINE AVENUE
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City | MANSFIELD
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State | OH
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Zip | 44907
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Country | US
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Telephone | 419-756-5739
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Fax | 419-756-4968
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Provider Business Mailing Address
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Address Line | PO BOX 543
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City | LEWIS CENTER
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State | OH
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Zip | 43035
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Country | US
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Telephone | 740-549-2596
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Fax | 740-549-0047
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEBORAH LYNNE MORITZ
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Credential | MD
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Telephone | 419-756-5739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35054857M
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License Number State | OH
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