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General NPI Number Information
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NPI Number | 1679516595
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Entity Type | Individual
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Provider Name | JOSEPH L DEROSE OD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 698 BALTIMORE PIKE
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City | BEL AIR
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State | MD
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Zip | 21014-4264
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Country | US
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Telephone | 410-879-0044
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Fax | 410-893-6871
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Provider Business Mailing Address
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Address Line | 920 PROVIDENCE RD STE 100
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City | TOWSON
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State | MD
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Zip | 21286-2976
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Country | US
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Telephone | 703-847-8899
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Fax | 709-866-7954
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA0948
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License Number State | MD
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