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 |
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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 |
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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 |
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Provider Enumeration Date | 12/12/2007 |
Last Update Date | 12/12/2007 |
Medicare PECOS PAC ID | 6305924309 |
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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 |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1215095203 PECOS PAC ID: 8123195740 Enrollment ID: I20090630000490 |
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