{
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"FirstLineMailingAddress": "253 GARY DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHLANDS",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24641-2682",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "276-963-2231",
"MailingAddressFaxNumber": "276-964-9701",
"FirstLinePracticeLocationAddress": "3150 CLINCH ST",
"SecondLinePracticeLocationAddress": "SUITE 106",
"PracticeLocationAddressCityName": "RICHLANDS",
"PracticeLocationAddressStateName": "VA",
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"PracticeLocationAddressTelephoneNumber": "276-963-2231",
"PracticeLocationAddressFaxNumber": "276-964-9701",
"EnumerationDate": "11/10/2009",
"LastUpdateDate": "03/18/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATEL",
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"AuthorizedOfficialMiddleName": "G.",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "276-963-2231",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "0101037830",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}