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General NPI Number Information
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NPI Number | 1437583879
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA VALLEY VEIN CENTER, LLC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 1140 SHERIDAN ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-3618
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Country | US
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Telephone | 570-326-1100
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Fax | 570-326-4500
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Provider Business Mailing Address
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Address Line | 1140 SHERIDAN ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-3618
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Country | US
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Telephone | 570-326-1100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SUZAN A MCGARY
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Credential | M.D.
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Telephone | 570-326-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | MD043543E
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License Number State | PA
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