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General NPI Number Information
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NPI Number | 1659405843
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Entity Type | Organization
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Legal Business Name | MY FAMILY DOCTOR
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 722 GRANT ST SUITE A
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City | HERNDON
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State | VA
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Zip | 20170
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Country | US
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Telephone | 703-573-7200
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Fax | 703-547-0724
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Provider Business Mailing Address
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Address Line | 722 GRANT ST SUITE A
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City | HERNDON
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State | VA
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Zip | 20170
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Country | US
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Telephone | 703-573-7200
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Fax | 703-547-0724
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AMANDA E HILL
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Credential | CEO
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Telephone | 703-573-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101056112
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License Number State | VA
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