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General NPI Number Information
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NPI Number | 1922215607
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Entity Type | Individual
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Provider Name | FASIL M WUBU M.D,
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 954 FORREST ST
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City | BALTIMORE
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State | MD
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Zip | 21202-4236
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Country | US
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Telephone | 410-837-2135
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Fax |
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Provider Business Mailing Address
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Address Line | 9895 GOOD LUCK RD APT # 5
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City | LANHAM
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State | MD
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Zip | 20706-3221
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Country | US
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Telephone | 301-794-0008
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | D0064695
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License Number State | MD
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