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General NPI Number Information
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NPI Number | 1609273218
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Entity Type | Individual
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Provider Name | MARY JOSEPH
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Gender | Female
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 2160 SPRINGHILL FURNACE RD
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City | SMITHFIELD
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State | PA
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Zip | 15478-1428
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Country | US
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Telephone | 724-564-4690
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Fax |
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Provider Business Mailing Address
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Address Line | 527 MEDICAL PARK DR STE 401
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9010
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Country | US
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Telephone | 724-564-4690
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA057301
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License Number State | PA
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