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General NPI Number Information
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NPI Number | 1407102429
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Entity Type | Organization
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Legal Business Name | MIDATLANTIC VASCULAR, LLC
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 4036 RIVER OAKS DR UNIT B2
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-6695
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Country | US
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Telephone | 757-333-2066
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 EASTRIDGE RD
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City | RICHMOND
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State | VA
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Zip | 23229-5501
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Country | US
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Telephone | 757-333-2066
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | ANGELA N SCHWARZKOPF
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Credential |
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Telephone | 757-333-2066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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