Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD058898L | PA |
Y | 207VX0201X | Gynecologic Oncologist | MD058898L | PA |
NPI | 1154307239 |
---|---|
Provider Name | Dr. Thomas C. Randall |
First Address | Philadelphia, PA 19107-5701 |
Second Address | Philadelphia, PA 19107-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 03/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G11361 | (02) | PA |