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General NPI Number Information
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NPI Number | 1720068679
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Entity Type | Individual
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Provider Name | RAFAEL P SQUITIERI MD
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 2800 MAIN STREET
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City | BRIDGEPORT
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State | CT
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Zip | 06606
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Country | US
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Telephone | 203-576-5708
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Fax | 203-367-8392
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Provider Business Mailing Address
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Address Line | 1177 SUMMER ST
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City | STAMFORD
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State | CT
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Zip | 06905-5572
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Country | US
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Telephone | 203-576-5708
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Fax | 203-367-8392
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 039409
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 039409
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License Number State | CT
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