Healthcare Provider Details

I. General information

NPI: 1114915279
Provider Name (Legal Business Name): VINCENT H RANDAISI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 27TH ST
PORTSMOUTH OH
45662-2640
US

IV. Provider business mailing address

1735 27TH ST STE B06
PORTSMOUTH OH
45662-2681
US

V. Phone/Fax

Practice location:
  • Phone: 740-356-8280
  • Fax: 740-353-8711
Mailing address:
  • Phone: 740-356-7942
  • Fax: 740-356-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number34007176
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: