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General NPI Number Information
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NPI Number | 1376064816
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Entity Type | Organization
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Legal Business Name | HEALTHY ROOTS MEDICINE, LLC
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 5415 W CEDAR LN STE 204B
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City | BETHESDA
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State | MD
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Zip | 20814-1524
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Country | US
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Telephone | 301-523-5808
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 871
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City | ASHBURN
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State | VA
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Zip | 20146-0871
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | DR. FARAMARZ JAFARI
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Credential | LAC
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Telephone | 301-523-5808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U02394
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License Number State | MD
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