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General NPI Number Information
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NPI Number | 1811395064
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Entity Type | Organization
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Legal Business Name | MANOMEDNET INC.
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 40 WRIGHT ST WING BAYSTATE RADIOLOGY
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City | PALMER
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State | MA
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Zip | 01069-1138
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Country | US
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Telephone | 413-284-5243
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Fax |
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Provider Business Mailing Address
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Address Line | 379 SILVER ST
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City | WILBRAHAM
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State | MA
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Zip | 01095-9811
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Country | US
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Telephone | 413-544-8998
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY C ALLARD
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Credential | M.D.
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Telephone | 413-284-5243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 42902
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License Number State | MA
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