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General NPI Number Information
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NPI Number | 1588779482
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Entity Type | Organization
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Legal Business Name | GULF COAST ALLERGY CENTER PA
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 3400 TAMIAMI TRL SUITE 201
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8102
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Country | US
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Telephone | 941-743-2277
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Fax | 941-743-2275
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Provider Business Mailing Address
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Address Line | PO BOX 494507
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City | PORT CHARLOTTE
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State | FL
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Zip | 33949-4507
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Country | US
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Telephone | 941-743-2277
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Fax | 941-743-2275
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. USHA CHANDRAHASA
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Credential | M.D.
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Telephone | 941-743-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | ME84695
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License Number State | FL
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