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General NPI Number Information
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NPI Number | 1942933254
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Entity Type | Individual
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Provider Name | THALIA LEOVARIE MADERA PA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 340 THOMPSON RD
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City | WEBSTER
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State | MA
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Zip | 01570-1509
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Country | US
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Telephone | 413-565-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 588 LONGMEADOW ST
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City | LONGMEADOW
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State | MA
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Zip | 01106-2292
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | PA101445
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License Number State | MA
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