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General NPI Number Information
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NPI Number | 1578552022
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Entity Type | Individual
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Provider Name | MANUCHER FARDI MD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 105 ERDMAN WAY
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City | LEOMINSTER
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State | MA
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Zip | 01453-1805
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Country | US
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Telephone | 978-466-7800
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Fax | 978-466-9333
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Provider Business Mailing Address
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Address Line | 58 EDGELAWN AVE UNIT #12
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-4479
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Country | US
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Telephone | 978-944-0981
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Fax | 978-466-9333
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 78320
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License Number State | MA
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