| Michael A. Randolph, Md Pc | |
|
200 E 33rd St Suite 136 Baltimore MD 21218-3322 | |
| (410) 261-8997 | |
| (410) 337-0385 |
| Full Name | Michael A. Randolph, Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 200 E 33rd St, Baltimore, Maryland |
| Authorized Official Name and Position | Michael A Randolph (OWNER) |
| Authorized Official Contact | 4102618977 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael A. Randolph, Md Pc 200 E 33rd St Suite 136 Baltimore MD 21218-3322 Ph: (410) 261-8997 | Michael A. Randolph, Md Pc 200 E 33rd St Suite 136 Baltimore MD 21218-3322 Ph: (410) 261-8997 |
| NPI Number | 1225211360 |
|---|---|
| Provider Enumeration Date | 12/12/2007 |
| Last Update Date | 12/12/2007 |
| Medicare PECOS PAC ID | 6305924309 |
|---|---|
| Medicare Enrollment ID | O20080506000513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225211360 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D0034680 (Maryland) | Primary |
| Provider Name | Michael Anthony Randolph |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215095203 PECOS PAC ID: 8123195740 Enrollment ID: I20090630000490 |
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