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General NPI Number Information
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NPI Number | 1871955492
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Entity Type | Individual
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Provider Name | MICHELLE M. MAENG MD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 40 TEMPLE ST STE 1B
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City | NEW HAVEN
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State | CT
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Zip | 06510-2715
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Country | US
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Telephone | 203-737-1578
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Fax |
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Provider Business Mailing Address
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Address Line | 40 TEMPLE ST STE 1B
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City | NEW HAVEN
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State | CT
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Zip | 06510-2715
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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 |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME145134
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License Number State | FL
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Taxonomy #2
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 71805
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License Number State | CT
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