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General NPI Number Information
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NPI Number | 1821390626
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Entity Type | Organization
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Legal Business Name | NORTHEAST MEDICAL GROUP INC
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 77 LAFAYETTE PL SUITE 290
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City | GREENWICH
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State | CT
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Zip | 06830-5426
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Country | US
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Telephone | 203-863-3701
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 417143
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City | BOSTON
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State | MA
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Zip | 02241-0001
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Country | US
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Telephone | 615-746-4711
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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. BRUCE MCDONALD
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Credential | MD
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Telephone | 203-384-3717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 047092
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License Number State | CT
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