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General NPI Number Information
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NPI Number | 1396268371
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Entity Type | Organization
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Legal Business Name | MEDDOC CENTRAL LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 5912 RIDGE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1639
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Country | US
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Telephone | 484-390-0378
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 112
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City | FAIRPLAY
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State | MD
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Zip | 21733-0112
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Country | US
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Telephone | 301-573-6858
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN GVODAS JR.
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Credential |
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Telephone | 484-390-0378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | G1-0001317
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License Number State | DE
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