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Individual

DR. JOHN JAMES RANDOLPH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
20 W PARK ST, STE 215, LEBANON, NH 03766-1378
(603) 448-6779
(603) 653-0246
Mailing address
20 W PARK ST, SUITE 215, LEBANON, NH 03766-1378
(603) 653-0330
(603) 653-0330

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
1027
NH
103T00000X
Psychologist
1027
NH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00068596
BLUE CROSS BLUE SHIELD
VT
01
06Y007347NH01
ANTHEM BLUE CROSS BLUE SH
NH
Enumeration date
06/17/2005
Last updated
03/04/2014
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