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General NPI Number Information
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NPI Number | 1578150322
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Entity Type | Individual
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Provider Name | FIONA HALLORAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 4170 CITY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1610
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Country | US
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Telephone | 215-871-6772
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Fax |
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Provider Business Mailing Address
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Address Line | 919 CONESTOGA RD STE 2-106
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City | BRYN MAWR
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State | PA
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Zip | 19010-1353
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Country | US
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Telephone | 610-525-5028
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Fax | 610-672-0424
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MA062816
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License Number State | PA
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