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General NPI Number Information
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NPI Number | 1548469224
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Entity Type | Individual
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Provider Name | MARTIN PETER CICHON MD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 704 GOLD HILL RD STE 1200
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City | FORT MILL
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State | SC
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Zip | 29715-8906
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Country | US
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Telephone | 704-667-3380
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19305
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City | CHARLOTTE
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State | NC
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Zip | 28219-9305
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2007-01748
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License Number State | NC
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