Individual
RANDY M BRODNIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO FACOG
Contact information
Practice address
150 COURTHOUSE RD STE 202, PRINCETON, WV 24740-2450
(304) 327-0531
(304) 324-0548
Mailing address
150 COURTHOUSE RD STE 202, PRINCETON, WV 24740-2450
(304) 327-0531
(304) 324-0548
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
1566
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0093390000
—
WV
01
—
6210970
VIRGINIA MEDICAID
VA
Enumeration date
09/13/2005
Last updated
02/04/2021
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