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General NPI Number Information
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NPI Number | 1396738779
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Entity Type | Individual
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Provider Name | RANDAL PAUL RIESETT MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 2470 LONGSTONE LN STE I
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City | MARRIOTTSVILLE
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State | MD
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Zip | 21104-1523
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Country | US
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Telephone | 410-910-2300
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Fax | 410-740-9134
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Provider Business Mailing Address
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Address Line | 2470 LONGSTONE LN STE I
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City | MARRIOTTSVILLE
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State | MD
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Zip | 21104-1523
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Country | US
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Telephone | 410-910-2300
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Fax | 410-740-9134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0058747
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License Number State | MD
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