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General NPI Number Information
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NPI Number | 1447538590
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Entity Type | Individual
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Provider Name | SELYNE SAMUEL M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 2300 MIAMI VALLEY DR STE 350
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City | CENTERVILLE
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State | OH
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Zip | 45459-1294
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Country | US
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Telephone | 937-424-2469
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Fax | 937-424-2479
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Provider Business Mailing Address
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Address Line | 3170 KETTERING BLVD BUILDING B 3RD FLOOR
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City | MOMRAINE
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State | OH
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Zip | 45439-1924
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Country | US
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Telephone | 937-991-3188
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Fax | 937-223-9811
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35-128714
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 35.128714
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License Number State | OH
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