Individual
DR. RANDALL L MIDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
801 S LOUDOUN STREET, WINCHESTER, VA 22601
(540) 667-5431
(540) 667-2655
Mailing address
102 DICK TURPIN COURT, STEPHENS CITY, VA 22655
(540) 869-2015
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
0803000079
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
088289
COMMUNITY HEALTH
VA
01
—
211030
BLUE CROSS BLUE SHIELD
VA
Enumeration date
09/02/2006
Last updated
05/29/2008
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