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General NPI Number Information
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NPI Number | 1588635296
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Entity Type | Individual
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Provider Name | JENNIFER NATICCHIA MD
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Gender | Female
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 80 TANNER ST
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City | HADDONFIELD
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State | NJ
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Zip | 08033-2453
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Country | US
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Telephone | 844-542-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 401 ROUTE 73 N 40 LAKE CENTER DRIVE SUITE 201A
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City | MARLTON
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State | NJ
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Zip | 08053-3425
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Country | US
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Telephone | 856-355-0340
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Fax | 856-355-0346
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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 | 25MA06243900
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License Number State | NJ
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