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General NPI Number Information
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NPI Number | 1740272228
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Entity Type | Individual
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Provider Name | KATHLEEN M GOTZMANN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 308 N UNION AVE
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-2825
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Country | US
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Telephone | 410-939-3121
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Fax | 410-939-8278
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Provider Business Mailing Address
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Address Line | 520 UPPER CHESAPEAKE DR
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City | BEL AIR
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State | MD
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Zip | 21014-4375
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Country | US
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Telephone | 443-643-4300
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Fax | 443-643-4351
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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 | D0052506
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License Number State | MD
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