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General NPI Number Information
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NPI Number | 1841485695
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Entity Type | Individual
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Provider Name | ALI KHODABANDEH M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 100 HOSPITAL ROAD STE. 2A
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City | LEOMINSTER
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State | MA
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Zip | 01453
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Country | US
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Telephone | 617-522-8110
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 726
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City | LEOMINSTER
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State | MA
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Zip | 01453
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Country | US
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Telephone | 978-466-2692
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Fax | 978-466-4754
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 231041
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 242004.
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 242004.
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License Number State | MA
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