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General NPI Number Information
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NPI Number | 1831490135
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Entity Type | Individual
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Provider Name | LUIS R. P. DA CONCEICAO PAC
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Gender | Male
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 901 HARRY S TRUMAN DR N
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-5477
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Country | US
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Telephone | 240-677-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 6461 230TH ST
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-2713
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Country | US
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Telephone | 516-901-5446
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA78442
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License Number State | MD
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