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General NPI Number Information
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NPI Number | 1780385435
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Entity Type | Individual
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Provider Name | CONNOR MAILE
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Gender | Male
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Dates
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Enumeration Date | 03/10/2023
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 4811 BUCKLEY RD
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City | LIVERPOOL
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State | NY
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Zip | 13088-3629
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Country | US
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Telephone | 315-457-9966
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Fax |
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Provider Business Mailing Address
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Address Line | 1135 SALT SPRINGS RD
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City | SYRACUSE
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State | NY
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Zip | 13224-1255
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Country | US
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Telephone | 845-490-1334
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 032715
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License Number State | NY
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