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General NPI Number Information
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NPI Number | 1407646060
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Entity Type | Individual
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Provider Name | RAZAN RIAD HALLAK MD
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 11958 WEST BROAD STREET
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City | RICHMOND
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State | VA
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Zip | 23233
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Country | US
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Telephone | 804-360-4669
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Fax | 804-364-6521
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Provider Business Mailing Address
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Address Line | 1200 E. BROAD STREET BOX 980257
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City | RICHMOND
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State | VA
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Zip | 23298-0257
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Country | US
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Telephone | 804-828-9783
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Fax | 804-828-5613
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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