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General NPI Number Information
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NPI Number | 1760455307
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Entity Type | Individual
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Provider Name | ROBERT E. DEMARTINO M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WALTER REED ARMY MEDICAL CENTER 6900 GEORGIA AVE.
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City | WASHINGTON
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State | DC
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Zip | 20307-0001
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Country | US
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Telephone | 202-782-3501
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 QUEBEC ST NW APT. 724
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City | WASHINGTON
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State | DC
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Zip | 20008-1227
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Country | US
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Telephone | 202-237-9052
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 58668
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License Number State | MA
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