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General NPI Number Information
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NPI Number | 1770308678
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Entity Type | Organization
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Legal Business Name | CASA DE SANTE INC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 300 BROOKSIDE AVE
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City | AMBLER
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State | PA
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Zip | 19002-3436
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Country | US
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Telephone | 609-542-0185
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Fax |
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Provider Business Mailing Address
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Address Line | 2605 BRIDLE PATH RD
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City | EAST NORRITON
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State | PA
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Zip | 19403-3954
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Country | US
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Telephone | 443-345-7029
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ONIKEPE ADEGBOLA
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Credential | MD
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Telephone | 443-345-7029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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