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General NPI Number Information
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NPI Number | 1619134392
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Entity Type | Individual
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Provider Name | SUMA SHANKAR MAGGE MD
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Gender | Female
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 08/09/2017
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Provider Practice Location Address
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Address Line | 101 WASHINGTON BLVD APT 1019
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City | STAMFORD
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State | CT
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Zip | 06902-6844
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Country | US
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Telephone | 617-784-5737
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Fax |
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Provider Business Mailing Address
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Address Line | 40 CROSS ST FL 4
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City | NORWALK
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State | CT
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Zip | 06851-4647
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Country | US
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Telephone | 203-845-4800
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 051696
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 051696
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License Number State | CT
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