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General NPI Number Information
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NPI Number | 1356364608
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Entity Type | Individual
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Provider Name | CHARLES T LAU MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE HB6
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-1014
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Fax |
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Provider Business Mailing Address
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Address Line | 8582 SOMERSET DR
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-3422
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Country | US
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Telephone | 415-938-6815
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD427217
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C133930
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License Number State | CA
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