Individual
FREDERICK WILLIAM RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2607 RHAWN ST, PHILADELPHIA, PA 19152-3038
(215) 333-0304
(215) 333-1402
Mailing address
2607 RHAWN ST, PHILADELPHIA, PA 19152-3038
(215) 333-0304
(215) 333-1402
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
D0019085
MD
207P00000X
Emergency Medicine Physician
MD447333
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10433266
CAQH
—
05
—
368731700
—
MD
Enumeration date
06/22/2006
Last updated
07/09/2019
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