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General NPI Number Information
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NPI Number | 1740213867
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Entity Type | Individual
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Provider Name | CHARLES J VIVIANO MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 3480 WAKE FOREST RD STE 506
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City | RALEIGH
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State | NC
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Zip | 27609-7376
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Country | US
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Telephone | 919-862-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 5213 S ALSTON AVE
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City | DURHAM
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State | NC
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Zip | 27713-4430
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Country | US
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Telephone | 919-684-8111
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 044379
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2011-00406
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License Number State | NC
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