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General NPI Number Information
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NPI Number | 1982022430
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Entity Type | Individual
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Provider Name | KATE P DOMINGUEZ
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Gender | Female
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 5710 SPRINGFIELD DR.
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City | BETHESDA
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State | MD
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Zip | 20816
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Country | US
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Telephone | 301-233-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 251 E HURON ST
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City | CHICAGO
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State | IL
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Zip | 60611-2908
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Country | US
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Telephone | 301-233-3533
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | D95273
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License Number State | MD
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