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General NPI Number Information
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NPI Number | 1356335095
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Entity Type | Individual
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Provider Name | KELLIE BOBBITT SMALDORE DO
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Gender | Female
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 2227 OLD EMMORTON RD STE 218
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City | BEL AIR
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State | MD
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Zip | 21015-6189
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Country | US
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Telephone | 443-371-4940
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Fax | 443-371-4941
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Provider Business Mailing Address
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Address Line | 2227 OLD EMMORTON RD STE 218
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City | BEL AIR
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State | MD
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Zip | 21015-6189
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Country | US
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Telephone | 443-371-4940
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Fax | 443-371-4941
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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 | H40582
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0040582
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License Number State | MD
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