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General NPI Number Information
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NPI Number | 1912589870
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Entity Type | Individual
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Provider Name | MICHAELA LYNN HALLER
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Gender | Female
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 317 S MANNING BLVD STE 220
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City | ALBANY
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State | NY
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Zip | 12208-3909
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Country | US
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Telephone | 518-525-6418
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Fax | 518-525-5016
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Provider Business Mailing Address
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Address Line | 70 CONSTITUTION RD
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City | CHARLESTOWN
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State | MA
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Zip | 02129-2038
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Country | US
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Telephone | 978-505-8628
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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