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General NPI Number Information
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NPI Number | 1922496645
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Entity Type | Organization
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Legal Business Name | EDMUND H. ERNST, M.D.
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 157 KILSYTH RD
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City | BRIGHTON
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State | MA
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Zip | 02135-7833
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Country | US
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Telephone | 857-919-1244
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Fax |
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Provider Business Mailing Address
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Address Line | 157 KILSYTH RD
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City | BRIGHTON
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State | MA
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Zip | 02135-7833
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Country | US
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Telephone | 857-919-1244
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. EDMUND H. ERNST
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Credential | M.D.
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Telephone | 857-919-1244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 31992
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License Number State | MA
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