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General NPI Number Information
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NPI Number | 1316176761
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Entity Type | Individual
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Provider Name | TARAK C REDDY MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 7300 VAN DUSEN RD
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City | LAUREL
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State | MD
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Zip | 20707-9463
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Country | US
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Telephone | 301-362-2042
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Fax | 240-568-2933
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Provider Business Mailing Address
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Address Line | 35 S SAINT CLAIR ST APT 401
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City | DAYTON
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State | OH
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Zip | 45402-2127
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Country | US
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Telephone | 937-409-6753
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0069090
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License Number State | MD
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