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General NPI Number Information
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NPI Number | 1992065528
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Entity Type | Individual
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Provider Name | NIMALAN VIPULANANDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 45 GOLDEN CRESCENT WAY
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City | ORCHARD PARK
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State | NY
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Zip | 14127-4913
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Country | US
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Telephone | 816-914-1197
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Fax |
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Provider Business Mailing Address
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Address Line | 333 BORTHWICK AVE
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City | PORTSMOUTH
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State | NH
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Zip | 03801-7128
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Country | US
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Telephone | 816-914-1197
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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 | 17450
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 17450
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License Number State | NH
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