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General NPI Number Information
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NPI Number | 1811197718
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Entity Type | Organization
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Legal Business Name | ALBANY THORACIC AND ESOPHAGEAL SURGERY, PLLC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 317 S MANNING BLVD SUITE 280
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City | ALBANY
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State | NY
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Zip | 12208-1738
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Country | US
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Telephone | 518-581-8739
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Fax | 518-581-8742
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Provider Business Mailing Address
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Address Line | 317 S MANNING BLVD SUITE 280
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City | ALBANY
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State | NY
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Zip | 12208-1738
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Country | US
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Telephone | 518-581-8739
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Fax | 518-581-8742
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Authorized Official
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Title or Position | M.D./OWNER
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Name | DR. DARROCH W.O. MOORES
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Credential | M.D.
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Telephone | 518-581-8739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 161924-1
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License Number State | NY
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