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General NPI Number Information
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NPI Number | 1457738122
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Entity Type | Organization
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Legal Business Name | MEDICAL AMBASSADOR HEALTHCARE, LLC
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 1220 L ST NW SUITE 100-275
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City | WASHINGTON
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State | DC
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Zip | 20005-4018
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Country | US
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Telephone | 202-705-2455
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Fax | 202-315-2511
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Provider Business Mailing Address
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Address Line | 1220 L ST NW SUITE 100-275
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City | WASHINGTON
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State | DC
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Zip | 20005-4018
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Country | US
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Telephone | 202-705-2455
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Fax | 202-315-2511
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Authorized Official
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Title or Position | OWNER
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Name | CAMILLE AWANDA
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Credential | N.P.
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Telephone | 301-343-7514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | RN1004831
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License Number State | DC
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