MEDICARE: RANDALL A COLUCCI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34-007244	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184618027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL A COLUCCI DO

Provider Business Mailing Address
First Line	:	75 HOSPITAL DR
Second Line	:	SUITE 200, CASTROP CENTER
City	:	ATHENS
State	:	OH
Zip	:	45701-2857
Country	:	US
Telephone Number	:	740-566-4880
Fax Number	:	740-566-4881

Provider Business Practice Location Address
First Line	:	75 HOSPITAL DR
Second Line	:	SUITE 200, CASTROP CENTER
City	:	ATHENS
State	:	OH
Zip	:	45701-2857
Country	:	US
Telephone Number	:	740-566-4880
Fax Number	:	740-566-4881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	09/23/2010

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Directions to “ RANDALL A COLUCCI DO” Practice Location

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