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General NPI Number Information
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NPI Number | 1710944707
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Entity Type | Individual
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Provider Name | HABIB FOUAD BASSIL MD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 2232 WILBORN AVE SUITE A
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-1662
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Country | US
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Telephone | 434-572-8977
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Fax | 434-572-2510
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Provider Business Mailing Address
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Address Line | 4402 BRENTWOOD DR
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2955
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Country | US
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Telephone | 434-572-1381
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Fax | 434-572-1381
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101044555
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License Number State | VA
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