example - radiologist w10000 tate an asalt nsane 1 enes ... · frankfort ny 13340 13502 g2111119...

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W910000 State and Casualty Insurance 17 Avengers Street Walker, Diana 07 12 1982 21 Acme Valley Road 17 Calvary Drive Frankfort NY 13340 5555555 13502 2222222 G2111119 Walker^^^Diana Y4 Y0078792156 State and Casualty Insurance Signature on File 05 27 2018 431 0B 110300 DN Leon Mandrake 5999777777 REFX5003333-4^^^G2RAD^^^PWK06EAC00985621^^^NTEADD20200302 0 M79672 OB 003333 01 15 20 01 15 20 11 73630 LT A 86 12 1 6000888888 160001111 0078 86 12 333 3333333 Bangalla Imaging Associates Bangalla Imaging Associates 65 Wanderlust Circle 65 Wanderlust Circle Anthony Lothar, MD Syracuse NY 13208 Syracuse NY 13208 01/16/2020 4888999999 4888999999 White Plains, NY 10604 123-45-6788 Xanadu Enterprises Utica NY 222 555 EXAMPLE - RADIOLOGIST X

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Page 1: EXAMPLE - RADIOLOGIST W10000 tate an asalt nsane 1 enes ... · Frankfort NY 13340 13502 G2111119 Walker^^^Diana Y4 Y0078792156 State and Casualty Insurance Signature on File 0527

W910000State and Casualty Insurance17 Avengers Street

Walker, Diana 07 12 1982

21 Acme Valley Road 17 Calvary Drive

Frankfort NY

13340 5555555 13502 2222222

G2111119

Walker^^^Diana Y4 Y0078792156

State and Casualty Insurance

Signature on File

05 27 2018 4310B 110300

DN Leon Mandrake 5999777777

REFX5003333-4^^^G2RAD^^^PWK06EAC00985621^^^NTEADD20200302

0M79672

OB 003333

01 15 20 01 15 20 11 73630 LT A 86 12 1 6000888888

160001111 0078 86 12333 3333333

Bangalla Imaging Associates Bangalla Imaging Associates65 Wanderlust Circle 65 Wanderlust Circle

Anthony Lothar, MD Syracuse NY 13208 Syracuse NY 1320801/16/2020 4888999999 4888999999

White Plains, NY 10604

123-45-6788

Xanadu Enterprises

Utica NY

222555

EXAMPLE - RADIOLOGIST

X