Individual
GLENN R RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
277 EAST MOUNTAIN ST, SUMMIT ELDERCARE, WORCESTER, MA 01606
(508) 852-2026
(508) 856-7130
Mailing address
277 EAST MOUNTAIN ST, SUMMIT ELDERCARE, WORCESTER, MA 01606
(508) 852-2026
(508) 856-7130
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
80026
MA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
80026
MA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
80026
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0400961
EVERCARE
—
01
—
042472266
HEALTHCARE VALUE MGMT
—
01
—
1061182
FIRST HEALTH
—
01
—
110175052
RAILROAD MEDICARE
—
01
—
27190
CHILDRENS MED SEC PLAN
—
05
—
3131335
—
MA
01
—
6633909
CIGNA HEALTH PLAN
—
01
—
7001328
AETNA US HEALTHCARE
—
01
—
784073
MVP HEALTH CARE
—
01
—
991122
FALLON COMMUNITY HEALTH P
—
01
—
AA2364
HARVARD PILGRIM HEALTHCAR
—
01
—
J14922
BLUE SHIELD INDEMNITY
—
Enumeration date
03/30/2006
Last updated
01/17/2014
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