Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 028839 | CT |
N | 111NI0900X | Internist | 028839 | CT |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 028839 | CT |
NPI | 1003839135 |
---|---|
Provider Name | Pamela Joy Randolph |
First Address | Wilton, CT 06897 |
Second Address | Wilton, CT 06897 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 13/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001288390 | (05) | CT |
E46914 | (02) | CT |