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General NPI Number Information
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NPI Number | 1639269970
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Entity Type | Individual
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Provider Name | FRED E SANTORO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15 CHESTERFIELD RD FLANDERS PLAZA, SUITE 214
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City | EAST LYME
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State | CT
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Zip | 06333-1730
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Country | US
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Telephone | 860-739-0404
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Fax | 860-739-1881
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Provider Business Mailing Address
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Address Line | 15 CHESTERFIELD RD PO BOX 159
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City | EAST LYME
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State | CT
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Zip | 06333-1730
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Country | US
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Telephone | 860-739-0404
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Fax | 860-739-1881
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 029410
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License Number State | CT
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