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General NPI Number Information
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NPI Number | 1710243357
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Entity Type | Individual
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Provider Name | ANGELA CAROLE DIPOTO BRAHMBHATT MD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 510 E STONER AVE
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City | SHREVEPORT
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State | LA
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Zip | 71101-4243
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Country | US
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Telephone | 318-990-5392
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 W KIRBY PL
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City | SHREVEPORT
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State | LA
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Zip | 71103-3822
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Country | US
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Telephone | 318-626-0287
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD.207106
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | MD.207106
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License Number State | LA
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