Healthcare Provider Details

I. General information

NPI: 1962578021
Provider Name (Legal Business Name): RANDY ALAN INKLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST
PHILADELPHIA PA
19103-6231
US

IV. Provider business mailing address

255 S 17TH ST
PHILADELPHIA PA
19103-6231
US

V. Phone/Fax

Practice location:
  • Phone: 610-892-3800
  • Fax:
Mailing address:
  • Phone: 610-892-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD040445L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: