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General NPI Number Information
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NPI Number | 1578547121
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Entity Type | Individual
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Provider Name | SUSAN LOUISE STERLACCI MD
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Gender | Female
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 1400 8TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-4110
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Country | US
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Telephone | 817-698-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 3960 NOAH LN
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City | LEAGUE CITY
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State | TX
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Zip | 77573-3989
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Country | US
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Telephone | 631-838-3010
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 16136
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | X8157
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License Number State | TX
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