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General NPI Number Information
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NPI Number | 1952644429
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Entity Type | Individual
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Provider Name | MAURA ROSE MCTAGUE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2013
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 525 E 68TH ST
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City | NEW YORK
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State | NY
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Zip | 10065-4870
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Country | US
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Telephone | 212-746-4055
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 ARLINGTON AVE APARTMENT 2D
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City | BRONX
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State | NY
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Zip | 10471-1503
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Country | US
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Telephone | 917-376-7031
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 309885
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License Number State | NY
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