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General NPI Number Information
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NPI Number | 1811524580
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Entity Type | Individual
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Provider Name | SAMUEL SKAADEN COHEN DO
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Gender | Male
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 1 BOSTON MEDICAL CTR PL
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City | BOSTON
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State | MA
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Zip | 02118-2908
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Country | US
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Telephone | 978-500-4883
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Fax |
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Provider Business Mailing Address
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Address Line | 34 HAVERHILL ST
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City | LAWRENCE
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State | MA
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Zip | 01841-2884
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Country | US
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Telephone | 978-689-6683
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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 | 1016627
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License Number State | MA
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