Individual
WENDELL LEWIS RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
956 N MAIN ST, MOUNT AIRY, NC 27030-3747
(336) 648-8550
(336) 648-8551
Mailing address
956 N MAIN ST, MOUNT AIRY, NC 27030-3747
(336) 648-8550
(336) 648-8551
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
36016
NC
208D00000X
General Practice Physician
36016
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36016
NORTH CAROLINA MEDICAL BOARD MEDICAL LICENSE
NC
01
—
70121
BCBS INDIVIDUAL
NC
05
—
89070121
—
NC
01
—
VVF492B944
MEDICARE NUMBER
VA
Enumeration date
05/11/2006
Last updated
05/17/2023
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