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General NPI Number Information
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NPI Number | 1770802795
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Entity Type | Individual
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Provider Name | ATRAYEE BASU MALLICK M.D
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Gender | Female
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 1015 CHESTNUT ST SUITE 1321
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4316
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Country | US
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Telephone | 215-923-5676
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Fax | 215-923-7390
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Provider Business Mailing Address
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Address Line | 615 CHESTNUT ST 14TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19106-4404
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Country | US
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Telephone |
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD440064
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License Number State | PA
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