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General NPI Number Information
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NPI Number | 1356498893
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Entity Type | Individual
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Provider Name | GAYLORD SCOTT ROSE MD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 3289 WOODBURN RD SUITE 320
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City | ANNANDALE
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State | VA
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Zip | 22003-6800
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Country | US
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Telephone | 571-308-1830
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Fax | 571-308-1843
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Provider Business Mailing Address
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Address Line | 5801 POSTAL RD UNIT 81310
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City | CLEVELAND
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State | OH
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Zip | 44181-2112
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Country | US
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Telephone | 301-340-8339
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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 | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 0101242867
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License Number State | VA
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