Individual
CHARLES RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
260 MERRIMAC ST, NEWBURYPORT, MA 01950-2192
(978) 499-7200
(978) 499-7216
Mailing address
260 MERRIMAC ST, NEWBURYPORT, MA 01950-2192
(978) 499-7200
(978) 499-7216
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
54597
MA
207RP1001X
Pulmonary Disease Physician
Primary
54597
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014413
CIGNA
—
01
—
054597
TUFTS HEALTH PLAN
MA
05
—
110045489A
—
MA
01
—
48-00612
EVERCARE
MA
01
—
60720
HARVARD PILGRIM HEALTHCAR
MA
01
—
974558
NETWORK HEALTH
MA
01
—
A59300
ANTHEM BLUE CROSS
NH
01
—
J07241
BLUE CROSS BLUE SHIELD
MA
Enumeration date
06/17/2005
Last updated
06/18/2014
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