Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 80026 | MA |
N | 111NI0900X | Internist | 80026 | MA |
Y | 207RG0300X | Geriatric Medicine | 80026 | MA |
N | 207RH0002X | Hospice and Palliative Medicine | 80026 | MA |
NPI | 1033170972 |
---|---|
Provider Name | Glenn R Randall |
First Address | Worcester, MA 01606 |
Second Address | Worcester, MA 01606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 17/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0400961 | EVERCARE (01) | |
042472266 | HEALTHCARE VALUE MGMT (01) | |
042472266 | ONE HEALTH PLAN (01) | |
042472266 | PRIVATE HEALTHCARE SYSTEM (01) | |
1061182 | FIRST HEALTH (01) | |
110175052 | RAILROAD MEDICARE (01) | |
27190 | CHILDRENS MED SEC PLAN (01) | |
27190 | HEALTHY START (01) | |
3131335 | (05) | MA |
6633909 | CIGNA HEALTH PLAN (01) | |
7001328 | AETNA US HEALTHCARE (01) | |
784073 | MVP HEALTH CARE (01) | |
991122 | FALLON COMMUNITY HEALTH P (01) | |
AA2364 | HARVARD PILGRIM HEALTHCAR (01) | |
E87046 | (02) | |
J14922 | BLUE CARE ELECT (01) | |
J14922 | BLUE SHIELD HMO BLUE (01) | |
J14922 | BLUE SHIELD INDEMNITY (01) | |
J14922 | MEDICARE B (01) |