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General NPI Number Information
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NPI Number | 1679549620
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Entity Type | Individual
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Provider Name | PETER MICHAEL DEVITO M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 7600 SOUTHERN BLVD SUITE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-6085
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Country | US
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Telephone | 330-758-3985
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Fax | 330-758-4264
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Provider Business Mailing Address
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Address Line | 7600 SOUTHERN BLVD SUITE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-6085
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Country | US
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Telephone | 330-758-3985
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Fax | 330-758-4264
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35-64590
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License Number State | OH
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