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General NPI Number Information
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NPI Number | 1790004075
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Entity Type | Individual
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Provider Name | STEVEN PAUL MENARD D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 830 CHALKSTONE AVE
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City | PROVIDENCE
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State | RI
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Zip | 02908-4734
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Country | US
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Telephone | 401-243-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 830 CHALKSTONE AVE
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City | PROVIDENCE
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State | RI
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Zip | 02908-4734
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Country | US
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Telephone | 401-243-7100
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O-1040
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License Number State | ID
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