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General NPI Number Information
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NPI Number | 1780471284
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Entity Type | Individual
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Provider Name | ANDREW MALAY REAGAN PARAMEDIC (NRP)
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Gender | Male
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 350 S MAIN ST
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City | STOWE
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State | VT
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Zip | 05672-4489
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Country | US
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Telephone | 802-253-4315
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Fax |
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Provider Business Mailing Address
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Address Line | 42 COLONIAL RD UNIT 101
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City | FAIRFAX
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State | VT
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Zip | 05454-9520
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Country | US
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Telephone | 651-329-6452
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 105274
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License Number State | VT
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