Healthcare Provider Details

I. General information

NPI: 1447211040
Provider Name (Legal Business Name): RANDALL JAMES HILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/07/2023
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE SUITE 301
CHARLESTON WV
25302-3302
US

IV. Provider business mailing address

830 PENNSYLVANIA AVE SUITE 301
CHARLESTON WV
25302-3302
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-4455
  • Fax: 304-346-4457
Mailing address:
  • Phone: 304-346-4455
  • Fax: 304-346-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number13989
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: