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General NPI Number Information
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NPI Number | 1801021951
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Entity Type | Organization
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Legal Business Name | COORDINATED PRIMARY CARE, INC
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 1069 CENTRAL ST
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City | LEOMINSTER
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State | MA
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Zip | 01453-4805
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Country | US
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Telephone | 978-534-3500
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Fax | 978-466-6307
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Provider Business Mailing Address
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Address Line | 1069 CENTRAL ST
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City | LEOMINSTER
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State | MA
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Zip | 01453-4805
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Country | US
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Telephone | 978-534-3500
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Fax | 978-466-6307
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PHYLLIS FABELLO
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Credential |
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Telephone | 978-466-4243
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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 |
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License Number State |
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