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General NPI Number Information
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NPI Number | 1508069659
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Entity Type | Individual
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Provider Name | VIDYA MATHIVANAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 16659 SOUTHWEST FWY
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City | SUGAR LAND
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State | TX
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Zip | 77479-2375
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Country | US
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Telephone | 281-812-7404
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Fax |
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Provider Business Mailing Address
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Address Line | 2607 GALLION DR
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City | SUGAR LAND
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State | TX
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Zip | 77479-1967
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Country | US
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Telephone | 281-812-7404
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N 3875
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License Number State | TX
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