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General NPI Number Information
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NPI Number | 1649701590
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Entity Type | Individual
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Provider Name | ANDREW MCNICOL MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 1330 COSHOCTON AVE STE C
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City | MOUNT VERNON
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State | OH
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Zip | 43050-1440
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Country | US
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Telephone | 740-393-9866
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Fax |
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Provider Business Mailing Address
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Address Line | 853 TAPESTRY DR APT 204
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City | LEWIS CENTER
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State | OH
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Zip | 43035-7817
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Country | US
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Telephone | 330-303-3051
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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 |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 35.144842
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License Number State | OH
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