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General NPI Number Information
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NPI Number | 1558366864
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Entity Type | Individual
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Provider Name | LUCIANO D'AMATO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 411 W MAIN ST
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City | WISE
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State | VA
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Zip | 24293-6904
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Country | US
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Telephone | 276-328-7050
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Fax | 273-328-2989
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Provider Business Mailing Address
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Address Line | PO BOX 3416
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City | WISE
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State | VA
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Zip | 24293-3416
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Country | US
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Telephone | 276-328-7050
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Fax | 276-328-2989
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101039667
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License Number State | VA
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