Healthcare Provider Details

I. General information

NPI: 1811265358
Provider Name (Legal Business Name): RANDOLPH CHARLES STINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 MONTGOMERY RD
MONTGOMERY OH
45242-4487
US

IV. Provider business mailing address

10506 MONTGOMERY RD
MONTGOMERY OH
45242-4487
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-4600
  • Fax:
Mailing address:
  • Phone: 513-865-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36199
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME88568
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2004006673
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-30623
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01053846A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.047737
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: