Individual
DR. FREDERICK RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1020 SANSOM ST, SUITE 239, PHILADELPHIA, PA 19107-5002
(215) 955-6844
(215) 955-2526
Mailing address
1020 SANSOM ST, SUITE 239, PHILADELPHIA, PA 19107-5002
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD419725
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100072
—
NJ
05
—
101026748
—
PA
05
—
1010267480005
—
PA
Enumeration date
04/28/2006
Last updated
12/09/2014
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