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General NPI Number Information
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NPI Number | 1609321611
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Entity Type | Organization
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Legal Business Name | COMPLETE DERMATOLOGY OF VIRGINIA, INC.
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 10721 MAIN ST SUITE 3100
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City | FAIRFAX
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State | VA
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Zip | 22030-6914
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Country | US
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Telephone | 703-281-0471
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Fax | 540-346-4642
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Provider Business Mailing Address
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Address Line | 10721 MAIN ST SUITE 3100
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City | FAIRFAX
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State | VA
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Zip | 22030-6914
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Country | US
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Telephone | 703-281-0471
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Fax | 540-346-4642
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. REENA VAID
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Credential | MD
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Telephone | 703-281-0471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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