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General NPI Number Information
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NPI Number | 1811547540
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Entity Type | Organization
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Legal Business Name | REVERED MEDICAL, LLC
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Dates
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Enumeration Date | 09/15/2019
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 6246 MONTROSE RD
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City | NORTH BETHESDA
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State | MD
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Zip | 20852-4119
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Country | US
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Telephone | 240-856-1393
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2151
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City | ROCKVILLE
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State | MD
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Zip | 20847-2151
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | MRS. JOSEPHINE MOORE
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Credential | NP
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Telephone | 240-856-1391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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