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General NPI Number Information
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NPI Number | 1972016897
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Entity Type | Individual
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Provider Name | TAYLOR HADLEY PA
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Gender | Male
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 3403 S DELSEA DR
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City | VINELAND
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State | NJ
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Zip | 08360-7449
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Country | US
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Telephone | 856-293-6974
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Fax |
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Provider Business Mailing Address
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Address Line | 333 N SHORE RD
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City | MARMORA
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State | NJ
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Zip | 08223-1601
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00453700
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License Number State | NJ
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