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General NPI Number Information
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NPI Number | 1710344718
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Entity Type | Organization
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Legal Business Name | STAFFORD NEUROLOGY
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 24 ONVILLE RD STE 205
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City | STAFFORD
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State | VA
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Zip | 22556-3831
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Country | US
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Telephone | 540-658-0825
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Fax | 540-658-0835
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Provider Business Mailing Address
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Address Line | 24 ONVILLE RD STE 205
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City | STAFFORD
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State | VA
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Zip | 22556-3831
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Country | US
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Telephone | 540-658-0825
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Fax | 540-658-0835
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL COHEN
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Credential | M.D.
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Telephone | 540-658-0825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0101032992
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License Number State | VA
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