Healthcare Provider Details

I. General information

NPI: 1508991985
Provider Name (Legal Business Name): DUDLEY RANDOLPH PRICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 WOODBURN ROAD WOODBURN CENTER FOR CMH
ANNANDALE VA
22003
US

IV. Provider business mailing address

4049 BIG PASS LN
PUNTA GORDA FL
33955-1880
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-5679
  • Fax:
Mailing address:
  • Phone: 941-505-2995
  • Fax: 941-505-2995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101025347
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD9241
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: