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General NPI Number Information
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NPI Number | 1891396107
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Entity Type | Organization
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Legal Business Name | MEDACUTE CARE LLC
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 313 SKYVIEW DR
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City | CUMBERLAND
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State | MD
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Zip | 21502-1929
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Country | US
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Telephone | 443-602-6207
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Fax |
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Provider Business Mailing Address
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Address Line | 2907 BEAU LN
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City | FAIRFAX
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State | VA
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Zip | 22031-1324
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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 | MD
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Name | DR. ARDALAN ENKESHAFI
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Credential | MD
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Telephone | 443-602-6207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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