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General NPI Number Information
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NPI Number | 1972148963
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Entity Type | Organization
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Legal Business Name | MY PRIMARY CARE
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 826 WASHINGTON RD STE 110
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City | WESTMINSTER
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State | MD
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Zip | 21157-5779
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Country | US
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Telephone | 443-604-4716
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Fax | 443-276-6572
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Provider Business Mailing Address
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Address Line | 11901 EVENING CT
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1252
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Country | US
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Telephone | 443-604-4716
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOCELYN SWANSON-APOLLON
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Credential | MD
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Telephone | 443-604-4716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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