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General NPI Number Information
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NPI Number | 1851617419
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Entity Type | Individual
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Provider Name | ETHAN SAUL WEINER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 20 CHAPMAN DR
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City | EAST LYME
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State | CT
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Zip | 06333-1001
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Country | US
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Telephone | 860-691-1661
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Fax | 860-760-6216
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Provider Business Mailing Address
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Address Line | 20 CHAPMAN DR
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City | EAST LYME
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State | CT
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Zip | 06333-1001
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Country | US
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Telephone | 860-691-1661
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Fax | 860-760-6216
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 025506
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License Number State | CT
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