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NPI Code Detail

MEDICARE: DR. RANDOLPH EUGENE MODLIN M.D.

MEDICARE: DR. RANDOLPH EUGENE MODLIN M.D.
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
1207RC0000XCardiovascular Disease Physician30837GA
2207RC0000XCardiovascular Disease Physician25813WV
3207RC0000XCardiovascular Disease Physician0101255193VA

General Provider Information

NPI Number : 1942259114
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDOLPH EUGENE MODLIN M.D.
Provider Business Mailing Address
First Line : 320 W MAIN ST
Second Line :
City : WHITE SULPHUR SPRINGS
State : WV
Zip : 24986-2414
Country : US
Telephone Number : 304-536-4870
Fax Number :
Provider Business Practice Location Address
First Line : 320 W MAIN ST
Second Line :
City : WHITE SULPHUR SPRINGS
State : WV
Zip : 24986-2414
Country : US
Telephone Number : 304-536-4870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 11/28/2016

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