MEDICARE: DR. RANDOLPH EWING LANFORD MD

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	0101032081	VA

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	:	1720114226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLPH EWING LANFORD MD

Provider Business Mailing Address
First Line	:	PO BOX 458
Second Line	:
City	:	FORK UNION
State	:	VA
Zip	:	23055
Country	:	US
Telephone Number	:	434-842-3244
Fax Number	:	434-842-1110

Provider Business Practice Location Address
First Line	:	4064 JAMES MADISON HWY
Second Line	:
City	:	FORK UNION
State	:	VA
Zip	:	23055
Country	:	US
Telephone Number	:	434-842-3244
Fax Number	:	434-842-1110

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/19/2010

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