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General NPI Number Information
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NPI Number | 1871019323
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Entity Type | Organization
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Legal Business Name | NTMT GROUP
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 8301 ARLINGTON BLVD STE 206
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City | FAIRFAX
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State | VA
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Zip | 22031-2902
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Country | US
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Telephone | 203-673-9656
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Fax |
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Provider Business Mailing Address
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Address Line | 13890 BRADDOCK RD STE 201
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City | CENTREVILLE
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State | VA
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Zip | 20121-2437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JASSER THIARA
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Credential |
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Telephone | 203-673-9656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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