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General NPI Number Information
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NPI Number | 1861831364
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Entity Type | Organization
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Legal Business Name | KALIKA P SRIVASTAVA MD PC
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 1444 MASSACHUSETTS AVE SUITE 103
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City | TROY
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State | NY
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Zip | 12180-1600
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Country | US
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Telephone | 518-272-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 1444 MASSACHUSETTS AVE SUITE 103
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City | TROY
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State | NY
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Zip | 12180-1600
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Country | US
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Telephone | 518-272-8181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KALIKA P SRIVASTAVA
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Credential | MD
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Telephone | 518-272-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 109015
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License Number State | NY
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