Individual
RANDY S KINNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10A MARSHELLEN DR, BEAUFORT, SC 29902-6900
(843) 379-9025
(304) 691-1693
Mailing address
10A MARSHELLEN DR, BEAUFORT, SC 29902-6900
(843) 379-9025
(304) 691-1693
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
83462
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000495918
OH MEDICAID UNISON
OH
05
—
0068881
—
OH
01
—
310917085156
OH MEDICAID CARESOURCE
OH
05
—
3810023588
—
WV
Enumeration date
06/24/2009
Last updated
03/26/2024
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