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General NPI Number Information
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NPI Number | 1942753694
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Entity Type | Organization
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Legal Business Name | CHANDER DEVARAJ MD LLC
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 920 FOXON RD
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City | EAST HAVEN
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State | CT
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Zip | 06513-1868
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Country | US
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Telephone | 203-468-9190
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Fax | 203-468-6952
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Provider Business Mailing Address
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Address Line | 920 FOXON RD
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City | EAST HAVEN
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State | CT
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Zip | 06513-1868
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Country | US
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Telephone | 203-468-9190
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Fax | 203-468-6952
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHANDER DEVARAJ
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Credential | M.D
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Telephone | 203-550-8348
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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 | 035401
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License Number State | CT
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