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General NPI Number Information
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NPI Number | 1902838071
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Entity Type | Individual
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Provider Name | MAURA SULLIVAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 2400 US ROUTE 9
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City | HUDSON
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State | NY
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Zip | 12534-4725
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Country | US
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Telephone | 518-537-4900
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Fax | 518-537-5977
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Provider Business Mailing Address
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Address Line | 28 CARRIAGE DR
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City | RED HOOK
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State | NY
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Zip | 12571-1230
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 210157
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License Number State | NY
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