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General NPI Number Information
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NPI Number | 1649482985
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Entity Type | Individual
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Provider Name | RUSSELL FOO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2007
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 763 S 8TH ST APARTMENT F3
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City | PHILADELPHIA
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State | PA
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Zip | 19147-2832
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Country | US
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Telephone | 215-380-6917
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MT 182446
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD434689
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License Number State | PA
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