{
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"OrgName": "THE VEIN AND LASER CENTER OF HANOVER",
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"FirstLineMailingAddress": "550 FAIRVIEW DR",
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"MailingAddressCityName": "HANOVER",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17331-9796",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-637-8464",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "221 POTOMAC AVE",
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"PracticeLocationAddressCityName": "HANOVER",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "717-637-1202",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/25/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARDEN",
"AuthorizedOfficialFirstName": "DEBORAH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRACTICE ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MRS.",
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"AuthorizedOfficialCredential": "M.B.A.",
"AuthorizedOfficialTelephoneNumber": "717-637-1202",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "MD-019142-E",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}