Healthcare Provider Details

I. General information

NPI: 1194916627
Provider Name (Legal Business Name): MICHAEL C. RANDON, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ISAAC ST
MIDDLEBORO MA
02346-2080
US

IV. Provider business mailing address

46 CLARA HOWARD WAY
NORTH EASTON MA
02356-1026
US

V. Phone/Fax

Practice location:
  • Phone: 508-947-9295
  • Fax: 508-947-7974
Mailing address:
  • Phone: 508-238-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL C. RANDON
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 508-238-6909