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Individual
MEDINA VERNON
Active
Individual
MEDINA VERNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
289877
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03874935
—
NY
Enumeration date
12/01/2014
Last updated
05/01/2018
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