Doctor Name: | CHRISTOPHER EUGENE RANDOLPH |
NPI Number: | 1649456492 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 2705111185 |
Business Practice Address: | 1317 Hales Ford Rd Moneta, VA - 241215989 |
Business Phone Number: | 5402971242 |
Business Fax Number: | 5402971242 |
Mailing Address: | 1317 Hales Ford Rd, MONETA |
State: | VA |
Postal Code: | 241215989 |
Phone Number: | 5402971242 |
Fax Number: | 5402971242 |
NPI Enumeration Date: | 01/10/2008 |
NPI Last Update Date: | 01/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171WH0202X |
License Number: | 2705111185 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Contractor |
Taxonomy Specialization: | Home Modifications |
Taxonomy Definition: |