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General NPI Number Information
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NPI Number | 1780112292
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Entity Type | Individual
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Provider Name | PAUL ANDREW WONTROSKI MD
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Gender | Male
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Dates
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Enumeration Date | 05/28/2017
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 1 PARK ST
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City | NEW HAVEN
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State | CT
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Zip | 06504-8901
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Country | US
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Telephone | 203-688-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 516 MAY DR
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City | SCRANTON
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State | PA
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Zip | 18505-4310
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Country | US
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Telephone | 570-344-8179
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD470489
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License Number State | PA
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