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General NPI Number Information
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NPI Number | 1437704103
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Entity Type | Individual
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Provider Name | MOSES EKEMEZIE IKEJIOFOR PMHNP
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Gender | Male
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 1501 SULGRAVE AVE STE 301
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City | BALTIMORE
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State | MD
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Zip | 21209-3651
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Country | US
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Telephone | 443-869-2550
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Fax | 443-869-2750
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Provider Business Mailing Address
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Address Line | 3711 STONEYBROOK RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4134
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Country | US
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Telephone | 443-858-3581
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R165493
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License Number State | MD
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