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General NPI Number Information
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NPI Number | 1619301439
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE ALLERGY AND ASTHMA CARE CENTER, LLC
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 12164 CENTRAL AVE SUITE 225
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-1944
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Country | US
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Telephone | 240-206-9601
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Fax | 240-206-9072
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Provider Business Mailing Address
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Address Line | 12164 CENTRAL AVE SUITE 225
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-1944
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Country | US
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Telephone | 240-206-9601
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Fax | 240-206-9072
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. TARYN R RICHARDSON
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Credential | M.D.
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Telephone | 240-206-9601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | D0068780
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License Number State | MD
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