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General NPI Number Information
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NPI Number | 1518197243
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Entity Type | Organization
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Legal Business Name | CLEVELAND CLINIC FOUNDATION
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 13700 FAIRHILL RD APT 401
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City | CLEVELAND
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State | OH
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Zip | 44120-1275
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Country | US
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Telephone | 347-513-0214
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Fax |
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Provider Business Mailing Address
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Address Line | 13700 FAIRHILL RD APT 401
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City | CLEVELAND
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State | OH
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Zip | 44120-1275
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Country | US
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Telephone | 347-513-0214
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Fax |
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Authorized Official
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Title or Position | ANESTHESIOLOGIST
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Name | DR. VASIL MAMALADZE
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Credential | MD
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Telephone | 347-513-0214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | T441115
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License Number State | PA
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