Individual
RANDY WAYNE CALICOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
200000741
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
200000741
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050086124
RR MEDICARE
—
01
—
126RJ
BLUE CROSS
NC
01
—
36495
PARTNERS
NC
01
—
5069608
AETNA
NC
05
—
7300263
—
VA
05
—
89126RJ
—
NC
05
—
9801180000
—
WV
01
—
98162
MEDCOST
NC
05
—
Q0074C
—
SC
Enumeration date
01/05/2006
Last updated
08/23/2017
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