Healthcare Provider Details

I. General information

NPI: 1407878846
Provider Name (Legal Business Name): RANDALL KEITH FALLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 BRAMBLETON AVE SUITE # 302
ROANOKE VA
24018-3436
US

IV. Provider business mailing address

PO BOX 20764
ROANOKE VA
24018-0077
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-4448
  • Fax: 540-772-0410
Mailing address:
  • Phone: 540-772-4448
  • Fax: 540-772-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101041068
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101041068
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: