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Individual
WENDELL LEWIS RANDALL
Active
Individual
WENDELL LEWIS RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
36016
NC
208D00000X
General Practice Physician
36016
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36016
NORTH CAROLINA MEDICAL BOARD MEDICAL LICENSE
NC
01
—
70121
BCBS INDIVIDUAL
NC
05
—
89070121
—
NC
01
—
VVF492B944
MEDICARE NUMBER
VA
Enumeration date
05/11/2006
Last updated
05/17/2023
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