Organization
WILLIAM E. RANDALL, JR., M.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM EDDY RANDALL JR. M.D. (OWNER)
(410) 823-1313
Entity
Organization
Contact information
Practice address
1205 YORK RD, SUITE 33, LUTHERVILLE, MD 21093-6210
(410) 823-1313
(410) 823-1316
Mailing address
1205 YORK RD, SUITE 33, LUTHERVILLE, MD 21093-6210
(410) 823-1313
(410) 823-1316
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
D0015808
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003951900
—
MD
01
—
06372
AMERIGROUP
—
01
—
34794001
BLUE SHIELD
—
01
—
4070033
AETNA
—
01
—
443218
AMERIHEALTH
—
01
—
E181
FEDERAL BS
—
Enumeration date
11/05/2009
Last updated
01/10/2010
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