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General NPI Number Information
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NPI Number | 1396893830
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Entity Type | Organization
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Legal Business Name | RANDOLPH V MERRICK, MD, PC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/05/2010
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Provider Practice Location Address
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Address Line | 303 MADISON RD SUITE B
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City | ORANGE
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State | VA
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Zip | 22960-1015
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Country | US
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Telephone | 540-661-0263
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Fax | 540-672-5264
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Provider Business Mailing Address
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Address Line | 303 MADISON RD SUITE B
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City | ORANGE
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State | VA
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Zip | 22960-1015
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Country | US
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Telephone | 540-661-0263
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Fax | 540-672-5264
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | RANDOLPH V MERRICK
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Credential | MD
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Telephone | 540-661-0263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101042580
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License Number State | VA
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