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General NPI Number Information
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NPI Number | 1770782195
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Entity Type | Individual
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Provider Name | CHARLES ANDREW CHADAKOFF PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 5380 S RAINBOW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89118-1877
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Country | US
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Telephone | 702-845-2841
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Fax | 702-252-4405
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Provider Business Mailing Address
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Address Line | 7326 LARAMIE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89113-3097
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Country | US
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Telephone | 702-787-4867
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Fax | 702-614-9928
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1050
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA1050
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License Number State | NV
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