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General NPI Number Information
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NPI Number | 1497573182
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Entity Type | Individual
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Provider Name | ANGELO FUSARO
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Gender | Male
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 14 CLARA DR
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City | MYSTIC
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State | CT
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Zip | 06355-1973
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Country | US
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Telephone | 860-245-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 213 HIGH ST
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City | WESTERLY
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State | RI
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Zip | 02891-1775
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Country | US
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Telephone | 401-430-9923
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 001036
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License Number State | CT
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