Healthcare Provider Details

I. General information

NPI: 1831114768
Provider Name (Legal Business Name): RANDAL H MEDZOYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E MAIN ST
ANNVILLE PA
17003
US

IV. Provider business mailing address

409 S 2ND ST STE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-867-4671
  • Fax:
Mailing address:
  • Phone: 717-867-4671
  • Fax: 717-867-4981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD074434L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: