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General NPI Number Information
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NPI Number | 1841308566
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Entity Type | Individual
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Provider Name | AMY L TRACE MD
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 493 BLACKWELL RD SUITE 202
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City | WARRENTON
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State | VA
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Zip | 20186-2639
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Country | US
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Telephone | 540-347-4400
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Fax | 540-341-4766
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Provider Business Mailing Address
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Address Line | PO BOX 748613 SUITE 202
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City | ATLANTA
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State | GA
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Zip | 30384-8613
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Country | US
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Telephone | 434-295-1000
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Fax | 540-341-4766
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101231302
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License Number State | VA
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